Enroll & Forms

To enroll in the Syracuse Lead Program, please use the PDF forms below:

Application (Part 1)
Program guidelines and requirements. All documents listed on the application along with Lead Tenant/Owner Data Form (Part 2), Blood Lead Authorization Form (Part 3) and Visiting Child Verification Form (if applicable) must be turned in prior to approval.   

Occupant Data Form (Part 2)
This form must be filled out by owner in owner-occupied situation and by the tenant in an investor-owned dwelling.  Each unit must complete and sign this form. 

Blood Lead Authorization Form (Part 3)
This form must be filled out by the parent or legal guardian of the occupying or visiting child. The child's name, DOB (date of birth) and signature on the bottom are required. By signing this form, the parent/legal guardian authorizes the Lead Program to receive a copy of the child's lead test records. Child between one and six (1-6) must be tested within six months of housing intervention.

Visiting Child Verification Form
This form must be filled out by the owner/tenant to certify that a child six or under spends at least two days per week, three hours per visit, 60 hours per year at residence, if there is not a child six or under living in the property.

Vacant Agreement
This form must be filled out if the property or a unit is vacant.   

When ALL requirements are met and ALL forms are completed and signed, please mail ALL required paperwork to the following address to proceed to the next step in the Program:

Syracuse Lead Program
201 E. Washington Street, Room 500
Syracuse, New York 13202