2. This Form Is For Non-Emergency Maintenance Requests
   If you are experiencing an emergency, please call 911. For water related emergencies, please call (219) 872-4430.
4. Resident's First Name*
5. Resident's Last Name*
7. Public Housing Street Address*
8. Suite or Apartment Number
10. Resident's Phone*
11. Resident's Email Address*
13. Please describe your maintenance request in detail:
Leave This Blank:


15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit Submit and Print

* indicates a required field