Repairs Pre-Application

PLEASE NOTE: This is a preliminary questionnaire and NOT an application.

If you meet pre-qualifications, you will receive an email with instructions on next steps to complete an actual application.
Name*

First NameLast Name
Email*
example@example.com
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
Phone Number*
Please enter a valid phone number.
What is your preferred language?*

EnglishSpanishFrenchOther
What is your preferred method of contact for future communication?*

EmailPhoneMail
Self Identification Survey

To help Habitat for Humanity qualify for grants and meet government reporting requirements, we invite applicants to complete the following self-identification survey. Participation is entirely voluntary, and your decision to provide or withhold this information will not affect your application or your eligibility for our programs in any way.

Any information provided will be kept confidential and used solely for reporting and compliance purposes.

As outlined in Habitat for Humanity’s Equal Opportunity policy, we do not discriminate based on any protected status under applicable laws.

Race & Ethnicity Definitions
Are you Hispanic/Latino?*
Please identify your race*
What is your gender?*
How do you describe your sexual orientation?*
Protected Veteran Status Survey

If you believe you belong to any of the categories of protected veterans listed below, please let us know by selecting the appropriate option. As a government contractor, Habitat for Humanity collects this information to measure how well we reach and support protected veterans as outlined under the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA).

Protected Veteran Categories:
- Disabled Veteran: A veteran who either receives disability compensation from the Department of Veterans Affairs (or would if not receiving military retirement pay) or was discharged from active duty due to a service-related disability.
- Recently Separated Veteran: A veteran discharged or released from active duty within the last three years.
- Active Duty Wartime or Campaign Badge Veteran: A veteran who served on active duty during a war or in a campaign/expedition that earned a campaign badge authorized by the Department of Defense.
- Armed Forces Service Medal Veteran: A veteran who earned an Armed Forces Service Medal while serving in a U.S. military operation authorized by Executive Order 12985.
Providing this information is voluntary, and it will not impact your eligibility for Habitat for Humanity’s programs. This information is kept confidential and used only for reporting purposes.
Veteran Status*
Voluntary Self-Identification of Disability

Why are we asking this question?
As part of Habitat for Humanity’s repairs program, we work with government programs that require us to collect information on the people we serve. This helps us ensure we are meeting program goals and qualifying for funding to continue supporting our community.

Your participation is voluntary.
You don’t have to answer these questions, but sharing this information helps us better serve you and others. Your answers are private and won’t affect your eligibility for our repairs program.

What counts as a disability?
A disability is a condition that limits one or more major life activities. If you have or ever had such a condition, you are considered a person with a disability. Some examples include:
- Vision issues, including blindness
- Hearing issues, including deafness
- Cancer (past or present)
- Diabetes
- Heart disease
- Mental health conditions like depression, anxiety, PTSD, or bipolar disorder
- Autism, ADHD, or other learning differences pilepsy or seizure disorders
- Mobility issues, including needing a wheelchair, walker, or other support
- Missing limbs or partial paralysis
- Chronic illnesses like multiple sclerosis (MS), Parkinson’s disease, or lupus
- Respiratory issues like asthma or emphysema
- Traumatic brain injury or intellectual disabilities
Thank you for helping us gather the information we need to continue improving our programs and reaching those in need.
Disability Status*
Household Minors

To help us better understand the needs of your household, please answer the following questions about any children under the age of 18 currently living in the home.
Are there any minors (under 18) living in the home?*

YesNo
How many minors live in the home?
Do any of the minors in your household have a disability?

YesNoPrefer not to say
Household Well-Being

To help us connect you with the right resources and better understand the challenges facing your household, please answer the following questions. Your responses will remain confidential and will not affect your eligibility for our repairs program.
Do you or members of your household have regular access to healthcare?

YesNoSometimesPrefer not to say
In the past 12 months, has your household worried about running out of food before you had money to buy more?

YesNoSometimesPrefer not to say
In the past 12 months, have you had difficulty keeping your home at a comfortable temperature due to the cost of heating or cooling?

YesNoSometimesPrefer not to say
Are there any other challenges your household is currently facing that you’d like to share?
Do you live in one of the areas highlighted on our map? Our service areas include Ada and Canyon Counties. The cities covered are: Boise, Caldwell, Eagle, Garden City, Hidden Springs, Kuna, Meridian, Middleton, Nampa, and Star. Check the map below to see if your location is included.*

YesNo
Do you own and live in the home in the highlighted area?*

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

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

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

YesNo
The income guidelines for Habitat for Humanity are defined by the U.S. Department of Housing and Urban Development (HUD) and include various forms of income, such as employment, public assistance, Social Security, disability, child support, and more. Our service areas in Canyon County and Ada County have different HUD guidelines, and your eligibility depends on which area you live in. The income range is between 30% and 80% of the Area Median Income (AMI).

For more information and to view the updated HUD Income Guidelines for each service area, please visit: HUD Income Guidelines.
Is your yearly household income within your area's income guidelines?*

YesNo
Which tier do the repairs you need fall into? We prioritize providing essential repairs to ensure safe and sustainable living conditions, particularly for older adults, enabling them to age in place comfortably and securely. Please select an option below:*

Tier 1: Aging in Place. Examples: Grab bars, handrails, smoke and CO2 alarms, minor lighting improvements, lever-style doorknobs, handheld adjustable shower heads, sliding bathtub seats, toilet seat lifts, etc.Tier 2: Accessibility Modifications. Examples: Wheelchair ramps, door repair/replacements, weatherization, etc.
How did you hear about Habitat for Humanity’s Repairs Program?*

Friend or family memberSocial media (Facebook, Instagram, etc.)Habitat for Humanity websiteCommunity eventFlyer or brochureChurch or religious organizationGovernment agency or nonprofitOther
Should be Empty:

PLEASE NOTE: This is a preliminary questionnaire and NOT an application.