Maricopa County Home Improvement Program (MCHIP) Inquiry Form
 
Maricopa County offers multiple types of assistance for income-eligible homeowners with home improvement, minor repairs, major rehabilitation, and energy efficiency services. Some programs may require forgivable liens (no payments or interest) to be placed upon the home. Individual program details will be discussed upon receipt of your inquiry.

Directions:

Fill out the confidential form below if you are a homeowner and interested in a home improvement program. Please note that completing this form should be considered a request for program information only. The form is not considered a pre-application or application form. Upon completion of the form, you will be contacted within 10 business days by a staff member to discuss your inquiry. If you require assistance with the completion of the form, or would like to request the form in paper or Spanish, please call 602-506-5911.
 
Referral Date:
Last Name:
First Name:
Gender:
Street Address:
Apt/Unit/Suite:
City:
State: AZ
ZIP:
Email Address:
Daytime Phone:
Phone Type:
Preferred Method Of Contact:
Primary Language:     If Other, please specify:   
How did you hear about us?: If Other:
Household Size:
Annual Gross Household Income:
Do You Own Home?:
Is This Home your Primary Residence?:
Are You On Title of Home?:
Are You Current On Mortgage?:
Is Home In Foreclosure?:
Are You Current On All Property Taxes?:
Do You Have Homeowners Insurance:?
Select House Type:
Year Home Was Built:
If not listed on deed, describe ownership details:
Utility Company (Select all that apply):
CheckedUtility Company
OTHER
APS
Southwest Gas
SRP
Select Program Types:
CheckedMCHIP Program
Energy Efficiency
Appliance Repair or Replace
Home Repairs (Wait List Full)
Describe what you would like to have done to your home: