Critical Home Repair Application
Thank you for your interest in She Built This City's Critical Home Repair Program. Our program provides free critical home repair services to qualified residents in Mecklenburg County. Our apprentices, who will be performing the repairs, are being trained by professionals who are dedicated to improving the safety and accessibility of your home. Please complete the following application to be considered for our program.
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Qualifications
Qualifications
Income at or below 70% Area Median Income
Owner Occupied Primary Residence
Have lived in the home at least 5 years
Current on Mortgage Payments if Applicable
Current on Property Taxes
Plan to remain in home for at least 5 years
Demographic Information
Date of Birth
-
Month
-
Day
Year
Date
Ethnicity
American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other
Gender
Male
Female
Other
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Property Information
What year was your home built?
Property Type
Single Family Home
Manufactured Home
Condo
Multifamily Home
Mobile Home
Additional Household Members
First Name
Last Name
Relationship
Spouse
Minor
Additional Family Member
Other
Additional Household Members
First Name
Last Name
Relationship
Spouse
Minor
Additional Family Member
Other
Additional Household Members
First Name
Last Name
Relationship
Spouse
Minor
Additional Family Member
Other
Additional Household Members
First Name
Last Name
Relationship
Spouse
Minor
Additional Family Member
Other
Select Service Requests Below
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( X )
Wheelchair Ramp
Existing ramp repair or new ramp installation
$
Free
Porch Repair
Existing porch repair includes removal and replacement of rotten wood
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Drywall Repair
Repairing drywall holes in walls that present a hazard. Repair only available if the source issue has been rectified.
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Handrails/Grab Bars
Interior or exterior handrail/grab bar installation for increased safety
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Flooring
Floor transition replacement or laminate repairs only. Whole flooring replacement not available.
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Faucet Repair/Replacement
Leaking kitchen or bathroom faucets may be repaired or replaced depending on the extent of the issue
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Toilet Repair/Replacement
Toilets may be repaired or replaced depending on the extent of the issue
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Electrical Outlet Replacement
GFCI outlet installation for wet areas and standard outlet replacement available.
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Light Fixture Replacement
Replacement is only available if current fixture poses a safety hazard.
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Exterior Door Replacement
Inoperable doors are available for replacement
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
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Income Documents
Income documentation required for applicant only.
Select Proof of Income Documentation Below
Please Select
SSI Award Letter/Retirement Benefits Statement
Most Recent 2 Months Bank Statements
New Employment Award Letter
Proof of Income
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Mortgage Statement (If Applicable)
Most Recent Current Mortgage Statement
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2024 Property Tax Bill
2024 Mecklenburg County Tax Bill
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By signing below I understand that I have read, understand, and agree to all of the terms of this application and that I am the primary owner of the subject property. I understand that the repairs will be completed by Apprentices enrolled in the She Built This City Program and are supervised by trained professionals. My signature further indicates that I declare and swear that if I receive critical home repairs, I will reside in my home for a minimum of five (5) years upon completion of such repairs.
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