Auto Repair Waitlist

Automotive Repair Assistance Program
Application Waitlist

Thank you for your interest in this program. Complete this brief questionnaire to be added to a waitlist. You will be contacted when you reach the front of the waitlist.
The Automotive Repair Assistance program is currently only available for employment-related purposes. Select one or more of the following ways your household qualifies for this program:*

I can provide paychecks from the past 30 days for at least one adult in the household who will be using the vehicle for transportation to their current job.I can provide documentation that at least one adult in the household is currently enrolled in a job-readiness program and the program/school does not provide free transportation.I can demonstrate that at least one adult in the household owns a registered business and provide their most recent filed tax documents.I cannot provide any of the above.
Check the box to indicate "yes" or leave it blank for "no":

Are you the owner of the vehicle?Are you a Butler County resident?Do you believe the total combined income of your adult household members is less than 200% of the federal poverty level?Can you provide proof of current active auto insurance in good standing?Can you provide proof of ownership (such as a title) or proof that your loan payments (if applicable) are in good standing and up to date?Can you provide proof that the vehicle is used for employment purposes, such as transportation to work or a job readiness program?Do you believe your vehicle can be repaired for less than $2500? Note: If the mechanic determines that the vehicle needs more than $2500 in repairs to make the vehicle road-safe, the vehicle will not qualify for this program.
Are you the owner of the vehicle?*
Are you a Butler County resident?*
Are you a US Citizen?*
Do you believe the total combined income of your adult household members is less than 200% of the federal poverty level?*
Approximate monthly thresholds: Single person $3000; Household of 2 $41000; Household of 3 $5100; Household of 4 $6200; Household of 5 $7300.
Can you provide proof of current active auto insurance in good standing?*
Can you provide proof of ownership (such as a title) or proof that your loan payments (if applicable) are in good standing and up to date?*
Can you provide proof that the vehicle is used for employment purposes, such as transportation to work or a job readiness program?*
Do you believe your vehicle can be repaired for less than $2500? *
If SELF's partner mechanic determines that the vehicle needs more than $2500 in repairs to make the vehicle road-safe, the vehicle will not qualify for this program. Please provide your best guess if it will qualify. SELF will contact you with more details when you reach the top of the waitlist. Do not take the vehicle to a mechanic.

Automotive Repair Assistance Program

Application Waitlist

We will email you when applications for the program are open. You will be contacted in the order you joined this waiting list.
Your Email Address:*
We will email you a notification when you reach the front of the waitlist.
Your Name:
Text Phone Number
We will text you a notification when you reach the front of the waitlist.

Automotive Repair Assistance Program

Application Waitlist

Unfortunately, due to one or more responses you provided on the prior page, you do not qualify for the SELF Automotive Repair Assistance Program.

HelpLink is available (toll-free) by dialing 2-1-1 from your phone. Helplink will connect you to a professionally-trained operator who will search for other programs for you.

If there is something wrong with this online form, please call 513-939-6728.
Should be Empty:

Automotive Repair Assistance Program

Application Waitlist

Automotive Repair Assistance Program

Application Waitlist

Automotive Repair Assistance Program

Application Waitlist