Get Started

Let's Get Started!

Let Us Know How We Can Help You

We're so glad you're here!

The two words we look forward to saying to you are “Welcome Home” – whether that’s to your newly built home or to a home that feels new because we’ve made the repairs you’ve needed for a long time.

The first step on the road to having a new or better home is to fill out and submit the form below. Once submitted, the form is automatically emailed to our staff, who will contact you as soon as possible about your next step.

Be aware that this is NOT an application, and we cannot determine whether you qualify for our program based on this form. This is simply an intake form, which lets us know what program or service you need and how we can contact you.

If you have questions, please call us at 606-436-0497 or email rebekah@hdahome.org You can also check out our FAQs to see if your question is answered there.

Ready for a brighter future? Submit the Intake/First Contact Form today!

"*" indicates required fields

Intake Form

Take your first step towards a new or better home by submitting this form! We will contact you ASAP about what you need to do next.

Name*

First Last

Mailing Address*

Street Address/P.O. Box Address Line 2 City State ZIP / Postal Code

Phone

Alternate Phone Number (if needed)

Which program are you interested in learning more about?*

Please select only one. If you have questions about other HDA programs/services, we will provide that information to you upon request.

Which county in our service area do you currently live in, or which county are you most interested in living?*

Please note that HDA only serves these counties in East Kentucky. You must already live in one of these counties or be willing to live in one of them.

Breathitt County

Floyd County

Knott County

Leslie County

Perry County

Message*

Briefly let us know how we can help you.

What is the best way to contact you?*

Phone

Text

Postal Mail

If text is selected as the best way to contact you, please provide your carrier.

How did you hear about us?*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

If you'd prefer not to submit an online form, just call us and request a paper application be mailed to you. You can either mail the completed form back to us, or you can fax it to our office. You may also simply come by our office to pick up or fill out a form!

Call: (606) 436-0497
TTY-711 (Hearing Impaired)

Fax: (606) 436-0598

Office Hours
Weekdays - 8:00 am - 5:00 pm

Let's Get Started!

We're so glad you're here!

Intake Form

If you'd prefer not to submit an online form, just call us and request a paper application be mailed to you. You can either mail the completed form back to us, or you can fax it to our office. You may also simply come by our office to pick up or fill out a form!

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