Neighbors Helping Neighbors Citizen Request Form

Please complete the form below to submit an application for the Neighbors Helping Neighbors Citizen Request Form.

Applicant Information

Are you 62 years of age or older? *
Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf.
Do you identify as disabled? *
Do you identify as low-moderate income? *
Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf.
Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf.
What activities do you need done to your property? *
Release of Information
Select an option *
Release of Liability
I do hereby release the City of Corinth, and the Neighborhood Services Department, and its officers, employees, contractors, representatives, and agents from any and all liability arising out of any services performed for me under the Neighbors Helping Neighbors Corinth program, including but not limited to, injuries to me, others persons, guests or invitees and damages to my property, equipment and/or belongings. I further agree to hold harmless and indemnify the City of Corinth and its officers, employees, contractors, representatives and agents for any all actions, causes of action, lawsuits, judgments, claims, demands, damages, costs, expenses, attorney fees and compensation on account of, arising out and/or in any growing out of any and all personal injuries and property damage which may hereafter be presented by anyone as a result of the actions or inaction of any person furnished to me through the Neighbors Helping Neighbors Corinth program.
Agreement *