Application for help
We ONLY provide repairs in North Metro Atlanta, GEORGIA (Gwinnett County, North Fulton, Forsyth and some surrounding areas depending on location). Requests for help outside of this area cannot be accommodated.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date of birth
*
How did you hear about us?
*
Marital status
*
Married
Widow
Widower
Single
Select if you are:
Disabled
Veteran
Is the home occupied by the owner?
*
Yes
No
Does any portion of the home serve as a rental unit?
*
Yes
No
If yes, list monthly rental income
*
Do you plan to live in the home for the next 3 years?
*
Yes
No
Are property taxes current?
*
Yes
No
Do you have homeowner’s insurance?
*
Yes
No
If yes, list insurance company and policy number
*
Have you filed for the Gwinnett Senior Homestead Exemption? (The Senior School Tax Exemption is a 100% exemption from taxes levied by the Gwinnett County Board of Education on your home and up to one acre of property. You must be 65 years old as of January 1 of the application year or 100% totally and permanently disabled and must occupy your residence within the Gwinnett County School District. There is an income limit, and you must provide documentation of your income for the prior year. More info here: https://gwinnetttaxcommissioner.publicaccessnow.com/PropertyTax/HomesteadExemption/SeniorHomesteadExemptionFAQ.aspx )
*
Yes
No
Have you received help from Home Repairs Ministries before?
*
Yes
No
If yes, when did you receive help?
*
Are there any liens on the property?
*
Yes
No
Is the property in foreclosure?
*
Yes
No
Do you own any other property?
*
Yes
No
If yes, estimated value of other property?
Home Repairs Ministries provides free labor to perform repairs. Are you able to pay for needed materials?
*
Yes
No
If yes, is there a limit of how much you can pay?
In the case of hardship and low-income households, funding is sometimes available for purchasing materials. Will you need this resource if available?
*
Yes
No
List household residents other than homeowner, their age, relationship to you, and if they are disabled or a veteran.
*
Monthly household income and source for all residents.
*
Please describe in detail the repair(s) you are requesting.
*
Please include photos, if available, of needed repairs.
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Certification & Understanding
The information that I have provided is true and correct to the best of my understanding. I can demonstrate through official documents all of the above. I understand that this application does not guarantee Home Repairs Ministries will perform any repairs. Repair work will be dependent upon funding and volunteer resources. I understand that abled-bodied occupants 18 or older will participate with project work. Repairs will be made at the sole discretion of Home Repairs Ministries. I authorize Home Repairs Ministries to share this information with their partner organizations.
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