Critical Home Repair

Critical Home Repair

Habitat Oakland County’s Critical Home Repair Program is a home preservation program that provides needed exterior repairs for homeowners in Oakland County, so that they may maintain a safe, decent, and affordable place to live. The Repair Program focuses on safety, security, accessibility and keeping houses up to building codes. Please complete the application below if you are interested in participating in our Critical Home Repair program and having exterior repairs completed on your home.
Contact Information
Name

First Name*Last Name*
Address

Street Address*

Street Address Line 2

City*State / Province*

Postal / Zip Code*
Phone Number*
Email*
Date of Birth*

MonthDayYear
Armed Forces Service*
If so, which branch of Military?
Household Information
How long have you lived in your home?*
Type of Home

Single FamilyDuplexCondoMobile Home
How many adults, 18 years or older, live in your household?* adults
How many children, 17 years or younger, live in your household?* children
Household Disability Status (optional)

One or more household members has a disabilityN/A
Do you have accessibility needs, interior or exterior, that are not being met? (installation of grab bars, widened doorways, wheelchair ramp, etc.)

YesNo
If so, please describe the need below:
Are you a DTE Customer?

YesNo
If so, was your refrigerator built prior to 2003?

YesNo
How did you hear about Habitat Oakland?*
If Habitat Homeowner or previous Rock the Block participant, please state Referring Homeowner Name below:
I would like to receive updates from Habitat Oakland

YesNo
Program Eligibility

Please answer the questions below to provide Habitat with information about your current housing status, ability to pay for repair services and your willingness to partner with our organization.
Homeownership* (Check All that Apply)

I am the legal owner of my home (my name is listed on the property deed)I am NOT the homeowner; I am currently renting the homeI have a land contractThis home is my primary residenceI am current on my mortgage or current on a payment plan for delinquent paymentsI am current on my property taxes or current on a payment plan for delinquent taxesI am current with my homeowner's insurance policy
If you are the legal owner, what date did you purchase your home?
If you are renting, you may still be eligible for some services however you would need consent from your landlord. Please provide their information below and Habitat will contact them if necessary.
Landlord Name and Landlord Phone or Email
Ability to Pay* (Check All that Apply)

I understand that Habitat will charge a reasonable fee for the services I am approved forMy fee will be reviewed with me and agreed upon prior to project approvalMy fee is due and shall be paid in full prior to the work day on my homeIf my project is approved, I will be charged an additional program administrative fee of $10
Willingness to Partner* (Check All that Apply)

I am willing to complete the required number of sweat equity hours for my home repair within the organizationI am willing to display partnership materials (lawn sign, stencil)
Critical Home Repair Service Available

This program focuses on exterior home repairs that will be completed by certified contractors. Included in this program is a FREE energy audit from the Consumers Energy Helping Neighbors Program for qualified households. A technician will come to your home to perform energy tests to help identify ways to reduce your energy costs. Some people are eligible for free energy upgrades. For more information about this FREE service, visit: consumershelpingneighbors.com. You will automatically be referred to this program. Below is a list of services available. Homeowners financially contribute to the completion of their project by paying a fee for services. The fee is determined by HFHOC staff after a home assessment has been completed.
My home is in NEED of one or more of the following services

Energy Audit to identify savingsReplace/repair home roofRepair/replace porch and stepsInstall wheelchair rampOther
If Energy Audit, what is your Consumers Energy account number?
Financial Information

Please select the sources of income for all members of your household. Ex: Job, Social Security, Child Support, etc. Please list the amounts BEFORE taxes.
Income Source #1
Income Source #1, How Often Are You Paid?
Income Source #1, Amount Per Check
Income Source #2
Income Source #2, How Often Are You Paid?
Income Source #2, Amount Per Check
Income Source #3
Income Source #3, How Often Are You Paid?
Income Source #3, Amount Per Check
Income Source #4
Income Source #4, How Often Are You Paid?
Income Source #4, Amount Per Check
*Authorization & Release* I understand that by submitting this application form, I am authorizing Habitat for Humanity of Oakland County (HFHOC) to evaluate my eligibility for home preservation services which includes a criminal background, sexual offender check, verification of homeownership and property tax status. I have answered all the questions on this form truthfully. The original or a copy of this form will be retained by HFHOC even if the application is not approved. HFHOC will only share the information on this application form with outside agencies offering services that I may be eligible for (such as OLHSA, Faith in Action and DTE Energy) and as needed to provide preservation services I select and are part of the program such as Consumers Energy.

I Agree
I understand that:

Completion of this form and initial site assessment does not guarantee that I receive repair services.Habitat must deem home in acceptable condition for requested work to be performed and those that do not will not be completed.
Please Fill Out Your Name as a Signature*
Information for Government Monitoring Purposes

The following information is requested by the federal government for housing programs in order to monitor the organizations compliance with fair housing law. You are not required to furnish this information, but are encouraged to do so. The law provides that an organization may neither discriminate on the basis of this information, nor on whether you choose to furnish it or not. However, if you choose not to furnish it, under federal regulations this organization is required to note race and sex on the basis of visual observation or surname.
If you do not wish to furnish the information below, please check the box below.

I do NOT wish to furnish this information
What race do you identify with?
If Other, Please Specify Race/National Origin
Do you consider yourself Hispanic, Latino, Latina, or of Spanish Origin?
What gender do you identify with?
If Other, Please Specify Gender Identity
I have read Habitat for Humanity of Oakland County's Privacy Policy

I Agree
Privacy Policy Below
Please verify that you are human*
Should be Empty:

Critical Home Repair

Contact Information

Household Information

Program Eligibility

Critical Home Repair Service Available

Financial Information

Information for Government Monitoring Purposes