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2. First Name*
3. Last Name*
5. Email Address*
6. Phone Number*
8. Address*
10. City*
11. State*
12. Zip Code*
14. How did you hear about Loveland Heights Grant Program?*
16. Are you the owner and occupant of the household?*

    1. No
    2. Yes
17. Do you have a proposed project?*

    1. No
    2. Yes
18. If yes, what is the estimated cost of the project?
20. If yes, briefly please describe project
22. By clicking yes, I confirm that I have read the program guidelines and am aware that I will be asked to provide additional information to confirm eligibility*

    1. Yes
23. By clicking yes, I acknowledge that if my application is approved, I will supply 50% of the project costs*

    1. Yes
25. Electronic Signature
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field