Homeownership: Pre-Eligibility Questionnaire

1065 Pinehurst Drive | PO Box 4717 | Rocky Mount, NC 27803
Phone: 252.977.3141
Fax: 252.977.2587
Emergency After-Hours: 252.977.6223
Office Hours: Monday - Friday | 8:30 am - 5:00 pm

Fields marked with * must be filled out or form will not submit.

If no Co-Applicant, put N/A or 0

After completing this form, please complete the next form: www.rm-ha.org/housing-counseling-disclosure-statement