I certify that the information on this application is accurate; that I own and reside in the property at the address given on this application; and that I have no present intention to move or offer my home for sale for at least 5 years. I confirm that any physically able persons residing in my home or visiting for the project day will work alongside the IHHFH volunteers. I confirm that except for the conditions above, the exterior of my home is a safe place for volunteers. I understand that by submitting this application, I am authorizing Iowa Heartland Habitat for Humanity to evaluate my need for home repairs, my ability to pay a percentage of project costs and my willingness to be a partner family. I understand that the evaluation will include a home assessment and income verification. I understand that my project may be subject to a 5 year deed restriction. I have answered all questions on this application truthfully. I understand that if I have not answered the questions truthfully, my application may be denied, and that even if I have already been selected to be eligible to receive Home Repairs services, I may be disqualified from the program. The original or a copy of this application will be retained by Iowa Heartland Habitat for Humanity even if the application is not approved.
If this application is created as (or converted into) an "electronic application," I consent to the use of "electronic records" and "electronic signatures" as the terms are defined in and governed by applicable federal and/or state electronic transaction laws. I intend to sign and have signed this application either using my: (a) electronic signature or (b) a written signature and agree that if a paper version of this application is converted into an electronic application, the application will be an electronic record, and the representation of my written signature on this application will be my binding electronic signature.