Home Repair Program Eligibility Questionnaire

Reasons you do not qualify:
PLEASE NOTE:
This is a preliminary questionnaire and NOT an application.
If you meet pre-qualifications, you will be added to our interest list. Once our application has been re-launched (exact date TBD), we will contact you regarding next steps.
Home Repair Program Eligibility Questionnaire
Name*

First NameLast Name
Email*
example@example.com
Street Address*
Street Address Line 2
City*
State*
Zip Code*
Please enter your zip code:
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
What is your preferred language?*

EnglishSpanishFrenchOther
Do you live in the City and County of Denver?

YesNo
Do you own and live in your home?*

YesNo
Do you own a single-family home or a townhome?*

YesNo
Does your home need critical exterior repairs such as: windows, doors, gutters, downspouts, siding and trim, fences, wheelchair ramp, or roof?*

YesNo
Are you current on ALL mortgage payments and property taxes?*

YesNo
Do you currently have an active homeowner’s insurance policy?*

YesNo
Has your home previously been repaired by Habitat Metro Denver?*

YesNo
When

MonthDayYear
Date
Is your gross monthly household income within our income guidelines? (Please see chart below.)*

YesNo

How did you hear about the program?*

Informational sessionFriends and/or familyCommunity eventOther organizationGovernment agencySocial mediaI’m a Habitat volunteerHabitat Metro Denver websiteHabitat newsletter or emailSchool eventPlace of worshipOther
Name

First NameLast Name
Email
example@example.com
Which community event?
Which informational session?
Which organization?
Which government agency?
Which school?
Which social media?
Which place of worship?
Should be Empty: