Healthy Homes Cary Application Form

Healthy Homes Cary Application Form
Thank you for your interest in the Town of Cary's Housing Rehabilitation Program. Please complete the following form and your request will be reviewed by staff. If you have questions about completing the form, please call 311 (or (919) 469-4000 if you are outside of Cary) or email 311@carync.gov and ask for the Housing and Community Partnerships department.
Program Application Part A - Initial Eligibility Screening Section

Please fill out this section first to help determine initial eligibility for the Program. Please answer each question below by checking your answer in the circle. Note: if the answer is "no" to any of the questions in Part A, you are ineligible for this program.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please check if your address is within Cary's Town limits:

1. Visit Cary's Property Research Map at https://maps.townofcary.org/propertyresearch/

2. In the top, righthand corner of the page, click on the icon for "Layer List" - it looks like three vertically stacked/layered squares

3. Select the box for "Government Boundaries" (should be the 8th option listed)

4. Type your address in the search bar at the top left of the page. If your property appears within the shaded orange area, it is within Town limits.
Is your home within the Town of Cary limits?*

YesNo
Have you owned and lived in your house for at least two years?*

YesNo
Is your home...*
Please choose one option
How many people live in your home?*
please type in a number
Is your total household income, per your household size, within the maximum Program limits shown on the Maximum Program Income Limit Chart below?*

YesNo
Image above displays maximum income eligibility for the Healthy Homes Cary program, which is based on 65% of Area Median Income. For a household of 1, that is currently $55,750; for a household of 2, $63,635; for a household of 3, $71,565; for a household of 4, $79,495; for a household of 5, $85,865; for a household of 6, $92,235; for a household of 7, $98,605; and for a household of 8, $104,975.

*Maximum Program income limits are based off of the United States Department of Housing and Urban Development (HUD) Wake County, Raleigh Metropolitan Statistical Area (MSA).
If you have any specific eligibility or Program questions,
please contact RTT by phone (919) 341-5980 or e-mail info@rebuildingtogethertriangle.org
Program Application Part B - Applicant Information

Please complete all sections of this application to prevent delays during the review process.
Applicant Information
Name*

First NameMiddle InitialLast NameSuffix
Birthdate*

MonthDayYear
Date
Primary Phone Number*
Alternate Phone Number*
Email*
example@example.com
Race/Ethnicity (may include more than one)*
Ex. Latina, Black, etc.
Names and birthdates of all household residents*
Ex. Harold Weinbrecht, 6/2/1956
Are any members of your household... (you may select more than one option)*

DisabledVeteran(s)None of my household members identify with the above characteristics.
Total Annual Household Income*
Reported income will be verified as part of the intake process
Do you have an HOA?*

YesNo
Please describe any other circumstances affecting your current living environment (health, disability, job loss, family hardship, etc.)
Please provide a general description of the work that is needed.
Along with your application, please submit the additional information detailed below.

For each wage-earning household member, please send copies of one of the options listed below. You may redact (i.e., mark through) any private information such as social security or bank account numbers.

∙ 2023 Social Security statement,
∙ 2023 Social Security Disability statement,
∙ Three (3) most recent bank statements,
∙ Three (3) most recent pay stubs,
∙ 2022 IRS Form W2,
∙ 2022 IRS Form 1099, or
∙ 2022 tax returns

You may mail, email, or fax your documents to:
2201 Brentwood Road, STE 109

Raleigh, NC 27604
Fax: (919) 651-0034
Email: info@rebuildingtogethertriangle.org
If you have any questions, please feel free to contact our office at (919) 341-5980

You can also take a picture and email that if it's easier.
Homeowner Acknowledgements

I understand that Rebuilding Together of the Triangle (RTT) is funded by the Town of Cary to provide assistance to low-income homeowners who have no other means to afford home repairs. By signing this statement, I guarantee that I am eligible to receive assistance.
I attest that the above statement of my total household income is accurate and complete to the best of my knowledge.*
Applicant please initial
I certify that all information provided on this application is complete and correct.*
Applicant please initial
I understand my application is not complete until I send RTT one of the acceptable documents (listed in the last paragraph before this Homeowner Acknowledgements section) per wage-earning household member.*
Applicant please initial
I understand I might be asked to provide additional information depending on program requirements.*
Applicant please initial
With permission, RTT may provide other programs with your contact information if we feel that a program may benefit you. This may include your name, address, phone number and annual income.*

I am willing for RTT to provide other agencies with my contact information.I am not willing for RTT to provide other agencies with my contact information.
Applicant Signature*

Clear
If you have any specific eligibility or Program questions, please contact RTT by phone (919) 341-5980 or email info@rebuildingtogethertriangle.org.

To find out more about RTT, please visit our website at: www.rttriangle.org

If you have questions about how the Town of Cary manages the Healthy Homes Cary program, please call 311 (or (919) 469-4000 if you are outside Cary) or email 311@carync.gov

Below, you have the option to submit the form, or save the form and continue working on it later. If you choose to only save at this time, a link to this form will be sent to your email. You'll click on that link when you're ready to continue working later. You do not have to create an account to continue working, simply click "Skip create an account" at the bottom of the pop-up window, when prompted.

Before submitting, you may print this form for your records, but you will also receive a copy of your finalized responses in your email.
Should be Empty:

Healthy Homes Cary Application Form

Program Application Part A - Initial Eligibility Screening Section

Program Application Part B - Applicant Information

Applicant Information

Homeowner Acknowledgements