•     2007 Wine and Jazz Festival
  •     2007 Celebrity Waiter Gala – Friday, Sept. 21, 2007 at the award-winning Anaheim White House
  •     2007 Annual Senior Holiday Luncheon – Monday December 10, 2007
  •     If you would like to be on our Special Events Invitation List...
Homeowner Application Form

Please check the city your home is in:
Anaheim      Santa Ana      Brea      Orange
Please complete the following application. Applications will be screened for eligibility and those meeting guidelines will be called for an in-person interview and house assessment. At that time, you will need to have copies of documents showing proof of income and home ownership.

Applications will be accepted on a on-going basis. By returning this application, you acknowledge your intent to neither list nor sell your home for at least one year following the applicable paint day.
Homeowners' Name(s): 
Address:
City: (Anaheim, Santa Ana, Brea or Orange only)
Zip: Phone:  
Date of Birth: (00/00/00 month/day/year).
Are you receiving disability benefits? Yes   No
If chosen, would you agree to speak to the press about PYHO? Yes   No
Please list all those, other than homeowner(s) over 18 living in the house:
Name:
Age: Monthly Income:  
Source:
Name:
Age: Monthly Income:  
Source:
Name:
Age: Monthly Income:  
Source:
Name:
Age: Monthly Income:  
Source:
Please list your monthly income including social security, SDI, pension, interest on savings, wages or any other income sources:
Social Security: $ Interest on Savings:  $
Pension: $ Wages:   $
SDI: $ Other Income:   $
Where do you work?  
What is your monthly income?  
     

You may also print and use the PDF forms below...
Homeowner Application (PDF file)

If you would like more information, you can also contact:
Debbie Schultz,
Program Director
Mail:      Debbie@pyho.org   OR   contactus@pyho.org
Phone:  714-970-1150.

Mail completed applications to:
PYHO
1260 N. Hancock Suite 103,
Anaheim, CA 92807

Thank you!


1260 N. Hancock, Suite 103, Anaheim, CA 92807 Phone: 714-970-1150, Fax: 714-970-1387

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