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  • Habitat for Humanity of Franklin County

HfH of Franklin County Critical Home Repair Application

Your Contact Information

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Co-Applicant Information

The maximum length for the field Co-Applicant First Name is 500 characters.
The maximum length for the field Co-Applicant Last Name is 500 characters.
The field Co-Applicant Email must be an email.
The field Co-Applicant Date of Birth must be a date.
The maximum length for the field Co-Applicant Address Line 1 is 500 characters.
The maximum length for the field Co-Applicant Address Line 2 is 500 characters.
The field Co-Applicant Phone must be a phone number.
The maximum length for the field City is 500 characters.
The maximum length for the field State is 500 characters.
The maximum length for the field Zip is 500 characters.

Household Information

The maximum length for the field Please list any additional household members, their relationship to the head of household, their age and gender is 500 characters.
The field Is any member of the household disabled? is required.
The maximum length for the field If so, please indicate the type of disability is 500 characters.

Property Information

The field How long have you lived at this residence? is required.
The field What type of property is the residence? is required.
The field Do you own the property or rent? is required.
The field Year Built: is required.
The field Year Purchased: is required.
The field Name(s) on deed or title of property: is required.
The field Property Insurance Company is required.
The field Policy # is required.
The field Expiration Date is required.
The field Do you have a property manager or an HOA? is required.
The field Do you own any other real estate? is required.

Household Income and Financial Information

Applicant

The field Estimated Monthly Wages must be a number.
The field SSI must be a number.
The field Disability must be a number.
The field SNAP (Food Stamps) must be a number.
The field VA Benefits must be a number.
The field Child Support Income must be a number.
The field Alimony Income must be a number.
The field Retirement (401k, Pension) must be a number.
The maximum length for the field Any additional sources of income? is 500 characters.

Household Income and Financial Information

Co-Applicant (if applicable)

The field Estimated Monthly Wages must be a number.
The field SSI must be a number.
The field Disability must be a number.
The field SNAP (Food Stamps) must be a number.
The field VA Benefits must be a number.
The field Child Support Income must be a number.
The field Alimony Income must be a number.
The field Retirement (401k, Pension) must be a number.
The maximum length for the field Any additional sources of income? is 500 characters.

Monthly Expenses

Please complete the following section with your current household expenses.

The field Lot Rental must be a number.
The field Homeowner's Insurance must be a number.
The field Electricity must be a number.
The field Water/Sewer must be a number.
The field Heating Oil/Gas must be a number.
The field Child Support must be a number.
The field Alimony Payment must be a number.
The field Cable/Internet must be a number.
The field Other Expenses must be a number.

Monthly Debt Payments

Please fill out the applicable fields in the section below.

The field Mortgage Payment Monthly must be a number.
The field Mortgage Payment Balance Remaining must be a number.
The field Car/Auto Loan Monthly Payment must be a number.
The field Car/Auto Loan Balance Remaining must be a number.
The field Medical Debt Monthly Payment must be a number.
The field Medical Debt Balance Remaining must be a number.
The field Student Loan Monthly Payment must be a number.
The field Student Loan Balance Remaining must be a number.
The field Credit Card Payment #1 must be a number.
The field Credit Card #1 Balance Remaining must be a number.
The field Credit Card Payment #2 must be a number.
The field Credit Card #2 Balance Remaining must be a number.
The field Credit Card Payment #3 must be a number.
The field Credit Card #3 Balance Remaining must be a number.
The maximum length for the field Please list any other monthly debt payments is 500 characters.

Additional Debt Information

The maximum length for the field If you answered "No" to any of the above questions about being current on monthly debt payments, please explain: is 5000 characters.
The field Do you have items in collection? is required.
The field If yes, what is the total $ amount in collections? must be a number.
The field Do you have any judgements or liens? is required.
The field If yes, what is the total $ amount? must be a number.
The field Have you declared bankruptcy in the past 7 years? is required.
The maximum length for the field If yes, what type, and when was it discharged? is 500 characters.

Requested Repairs

Please describe the repairs you are requesting next to the area of repair, otherwise leave section blank.

Habitat for Humanity of Franklin County may be unable to complete all of the repairs requested and prioritize repairs to complete based on homeowner affordability and the repairs effect on the safety, accessibility and preservation of the home.

The maximum length for the field Accessibility Modifications: Examples: Wheelchair ramp, bathroom grab bars, handrails, etc. is 5000 characters.
The maximum length for the field Interior Repairs: Describe problems with flooring, walls and ceilings, etc. is 5000 characters.
The maximum length for the field Doors and Windows: Describe any repairs to locks, glass, frames, weatherstripping, etc. is 5000 characters.
The maximum length for the field Roofing Repairs: Identify where the roof leaks. How many years has it been since the roof was replaced? is 5000 characters.
The maximum length for the field Exterior Repairs: Describe repairs required, including siding, skirting, painting, steps, etc. is 5000 characters.
The maximum length for the field Electrical/Plumbing: Identify all wall outlets, light fixtures, sink or toilet leaks, hot water heater repairs, HVAC issues, etc. is 5000 characters.
The maximum length for the field Other: Identify other repairs requested but not listed above. is 5000 characters.
The maximum length for the field Please share how these repairs will help improve your quality of life and/or the quality of the home: is 5000 characters.

Media and Publicity

Habitat for Humanity often works with corporate and/or church sponsors. these sponsors provide funds and/or volunteers for our projects. In celebration, some sponsors may wixh to publiize the event and/or information about the family.

By electronically signing below, I/We consent to having information released about our family to sponsors and for internal Habitat for Humanity publications inlcuding, but not limited to the organization's newsletter and website. This may include but is not limited to, photographs and interviews as well as in-home visits from elected officials.

The maximum length for the field Applicant E-Signature is 500 characters.
The maximum length for the field Co-Applicant E-Signature is 500 characters.
The field Date must be a date.

Information for Grant Monitoring Purposes

The following information is requested by the federal government and other funders in order to track the demographics of persons served. The law provides that we may neither discriminate on the basis of this information, nor on whether you choose to furnish it or not.

If you do not wish to furnish this information, please skip to the next section.

Records Check

This portion of the application is to further assist Habitat for Humanity of Franklin County in evaluating your eligibility for the repair program. The information provided through this portion of the application process will be kept confidential and reviewed only by the Executive Director and Program Administrator of Habitat for Humanity of Franklin County.

Please complete the following for each household member over eighteen years of age:

The maximum length for the field Applicant Full Name is 500 characters.
The field Applicant Date of Birth must be a date.
The maximum length for the field Applicant Social Security Number (SSN) is 500 characters.
The maximum length for the field Co-Applicant Full Name is 500 characters.
The field Co-Applicant Date of Birth must be a date.
The maximum length for the field Co-Applicant Social Security Number (SSN) is 500 characters.
The maximum length for the field Additional Household Member #1 Full Name is 500 characters.
The field Additional Household Member #1 Date of Birth must be a date.
The maximum length for the field Additional Household Member #1 Social Security # is 500 characters.
The maximum length for the field Additional Household Member #2 Full Name is 500 characters.
The field Additional Household Member #2 Date of Birth must be a date.
The maximum length for the field Additional Household Member #2 Social Security # is 500 characters.
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