Request Help

Emergency Assistance is based on funding availability for homeowners in need, that reside in Glendale, Peoria, Phoenix, Scottsdale, Surprise, El Mirage, Goodyear, Sun City, Sun City West or surrounding areas in Arizona.

See FAQ for additional qualifying information prior to submission.

Please complete the form to request assistance.

Allow at least 48 hours for the board to review and get back to you.

If approved, repairs will be completed by approved construction partners who agree to provide repairs at the lowest cost possible. Payment will be provided directly to the contractor.

After submitting your request, please look for an email from info@tylershouseaz.org for additional information and coordination.

This form is for emergency requests only, not for AHCCCS home modifications. Organizations requesting assistance with home modifications should reach out directly to Info@TylersHouseAZ.org

First Name

Last Name

Date of Request

Email Address

Phone

Age & ethnicity of all residing in the home.

Address of Home in Need of Repair (In Service Area)

Please describe the situation, what lead to this request and how it may adversely impact health or housing.

Any Estimates Received for Repair

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Evidence of Need

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Insurance or AHCCCS ID

Upload File

Picture of your family

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Please attach evidence of eligibility to request & look for an email response from info@tylershouseaz.org

*** By submitting this request, I confirm that I understand that assistance is based on available funding and is not guaranteed. +++

*** If approved, I agree to allow my story & photos to be published ***

Thanks for submitting!