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THE
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RENTAL & PROPERTY INFO
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CITY COUNCIL
NPAs
Lead
Relocation Questionnaire
1
Start
2
Complete
Name:
*
First and Last
Address:
*
Street Address, City, and Zip (remember to include unit #)
Are you filling out this form for just yourself or for your entire household?
*
Myself
My Entire Household
How many & what sizes of beds will your household require for relocation?
*
Do you have family & friends that you are able to stay with?
*
Do you have your own transportation?
*
Yes
No
Would you be comfortable using the local bus system? Do you have other ways of getting where you need to be?
*
Do you have any pets?
*
Yes
No
How many and what kind of pets?
*
Do you have someone who can take care of your pets while you relocate? Do your pets need to go outdoors?
*
Would you prefer to stay with family/friends and receive a daily stipend or in an apartment in the south end of Burlington (near T.J. Maxx)?
*
Is there any other information that you think would be helpful for us to know for your temporary relocation?
The Burlington Lead Program
Apply & Qualify
Grant and Loan Forgiveness
IRC Trainings & Vermont Lead Law
Lead Poisoning Prevention
Mortgage Discharges and Subordinations
Past Projects & Testimonials
Project Expectations & Evaluation
Relocation
Contact
BLP
802.865.5323 (LEAD)
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About us
M-F 9:00 am - 5:00 pm
149 Church St. Room 32
Burlington, VT 05401