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:
M
F
Street Address:
Apt/Unit/Suite:
City:
State:
AZ
ZIP:
Email Address:
Daytime Phone:
Phone Type:
Home
Work
Cell
Message
Bus Phone
Bus Fax
Preferred Method Of Contact:
Phone
Email
Primary Language:
English
Spanish (No English)
Other
If Other, please specify:
How did you hear about us?:
Friend
Family Member
Human Services Department
CAP Office
Website
211
Utility Company
Referral
Other
If Other:
Household Size:
Annual Gross Household Income:
5,000-10,000
10,001-20,000
20,001-30,000
30,001-40,000
40,001-50,000
50,000+
Do You Own Home?:
Yes
No
Is This Home your Primary Residence?:
Yes
No
Are You On Title of Home?:
Yes
No
Are You Current On Mortgage?:
Yes
No
Is Home In Foreclosure?:
Yes
No
Are You Current On All Property Taxes?:
Yes
No
Do You Have Homeowners Insurance:?
Yes
No
Select House Type:
Mobile Home
Modular
Single Family (Wood/Brick)
Condo Townhouse
Other
Year Home Was Built:
If not listed on deed, describe ownership details:
Utility Company (Select all that apply):
Checked
Utility Company
OTHER
APS
Southwest Gas
SRP
Select Program Types:
Checked
MCHIP Program
Energy Efficiency
Appliance Repair or Replace
Home Repairs (Wait List Full)
Describe what you would like to have done to your home: