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A Brush With Kindness

Home Repair Application

First Name *
Middle
Last Name *
Suffix
First Name
Middle
Last Name
Suffix
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Country
Address Line 1
Address Line 2
City
State/Province
Postal Code
Number of people living in home
Please list all sources AND amounts AND frequency of homeowner income, including jobs, Social Security, disability, retirement, chilld support, etc.
Have you or any member of your household served in the U.S. Armed Forces, including Coast Guard?
Does any member of your household have a disability?
Types of exterior repairs requested (check all that apply)
Type of interior repairs requested (check all that apply)
Information affirmation

*Habitat may not be able to perform all requests depending on extent and scope of work. Habitat also reserves the right to deny requests if there are other, more important repairs that need to occur first, or if the requested repairs would not make an appreciable impact – based on the staff’s judgement.

Exterior repairs can be made only to the first story of any home.
Roofing needs will be considered on a case-by-case basis.
Window replacement will be considered on a case-by-case basis.
Repairs requiring plumbing or electric work will be considered on a case-by-case basis.
Mobile homes will be considered case-by-case with a very limited scope of work.
 

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