Community Home Repair Program Inquiry Form

Please note HFHLC's program is not designed to be an emergency or crisis-based resource. This program typically has a waiting period. No homeowner will be forwarded an application on the spot.

Under Contact Information, please put your mailing address if different from your physical address.

Contact Information

First Name *

Last Name *

Email *

Gender

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Income Qualifications

This program has a maximum household annual income limits. Please check the income limits listed above for income limits.

Does your household have a total gross income below the levels listed in the chart above? * The field Does your household have a total gross income below the levels listed in the chart above? is required.

Present Housing Conditions

Physical Address: address, city, state, zip code * The field Physical Address: address, city, state, zip code is required.

Type of Home * The field Type of Home is required.

What year was your home built? Note: Manufactured homes built before 1972 are not eligible * The field What year was your home built? Note: Manufactured homes built before 1972 are not eligible is required.

Do you own this home? * The field Do you own this home? is required.

How long have you lived in the home? * The field How long have you lived in the home? is required.

Is there a mortgage on the home? * The field Is there a mortgage on the home? is required.

If there is a mortgage, are you current with your payments? * The field If there is a mortgage, are you current with your payments? is required.

Is your home insured? * The field Is your home insured? is required.

Do you own property other than your primary residence? * The field Do you own property other than your primary residence? is required.

Has HFHLC worked on your home before?

If yes, what was the approximate date and scope of the work ? The maximum length for the field If yes, what was the approximate date and scope of the work ? is 500 characters.

Demographic Information

Please note that while this information is voluntary, providing it will allow us to better match your repair request to appropriate funding sources.

Do you speak and read English?

Are you over 55 years of age?

Are you a veteran?

Do you have special needs or disabilities we should be aware of? The maximum length for the field Do you have special needs or disabilities we should be aware of? is 500 characters.

Home Repairs

Please briefly describe your home's needs. * The field Please briefly describe your home's needs. is required.

CHRP Application Preference

When the time comes, the CHRP application can be completed two different ways. Please review each selection below and choose the option that you prefer.

I affirm that I have read and understand all the information about Habitat for Humanity of Lincoln County's Home Repair Program located in the attached document.

I affirm * The field I affirm is required.

I understand that this program inquiry form is not the same as a program application, and that Habitat for Humanity of Lincoln County will mail me a program application directly as soon as there is funding applicable to my home's needs available.

I affirm * The field I affirm is required.

Document

Please read the attached document about the Community Home Repair Program.

Community Home Repair Program Information.pdf