Application Form 2025

Please complete the application below. Due to the high volume of applications, we apologize for the longer-than-usual waiting time.

Application Guidelines: All documents must be sent as a scan or clear picture of the document. Please attach documentation to the email. Applications missing required documents will be denied.

As listed below, income must not exceed 200% of the Federal Poverty Guideline. Provide a valid Driver's license. (You must have a Florida Driver's license) Provide proof of current car insurance. Provide proof of ownership of the vehicle (title or registration). If another shop has diagnosed the vehicle, (please provide a copy of the diagnostic results/estimate and proof of income (previous year Tax Return 1040 preferred). Fix It Forward only serves the Florida Counties: Orange, Seminole, and Volusia Counties.

. We will visit your location at your convenience and conduct an initial vehicle inspection. The technician will tell the customer what problems they found with the vehicle and if it qualifies for free repair.
200% of Federal Poverty Guidelines 2025
Household Size Anual Income
- 1 $30,120
- 2 $40,880
- 3 $51,640
- 4 $62,400
- 5 $73,160
- 6 $83,920
- 7 $94,680
- 8 $105,440
Car Repair Assistance Application:
Name of applicant (must be the registered owner of the car).*
Have you or anyone in your household received assistance from Fix It Forward in the Past 12 months.*
Address*
City, State, Zip*
Email Address
example@example.com
Home Phone
Marital Status*
The following information is for statistical proposes.*
Are you homeless?*
Are you a Veteran?*
Are you getting out of domestic violence situation?*
Are you a Female head of household?*
or non-dependent relative and provides more than half of the dependent's financial support Total number of in the household including foster children and your total household
income: (example: 5 members of the household; annual income $27,856)*
Name of Employer*
Hours per week*
Hourly Wage
Start Date

MonthDayYear
Date
List any other sources of income for your entire household including any financial assistance below
List all of the people who live at your residence. (add as many as necessary)
Name*
Relationship

MonthDayYear
Date
Relationship*
Driver's License #*
Does this person work (yes/no)*
Name*
Relationship

MonthDayYear
Date
Relationship*
Driver's License #*
Does this person work (yes/no)*
Vehicle Year/Make/Model/sub model*
Vehicle Identification # (VIN)*
Odometer Reading*
Describe any vehicle problems i.e. brake problems, suspension problems, making noises etc. NOTE: we do not work on transmission problems or engine repairs (refer to assistance guidelines section on our webpage).*
How will this service help you?
Please explain how our vehicle repair services can help you in your current situation. This is so we have a better understanding of your needs and how the program can better your life. Your statement WILL NOT be used for qualification. We may contact you at a future date to follow up on this statement.*
Can Fix It Forward use parts of your information on our website? Example: A generic description of your current situation and how Fix It Forward was able to help you.
No name or identifying information will be shared with the public? Y/N*
Do you consent to your photo being posted on our website? (we like to show our success stories and let people know how we are helping our community) Y/N*
Provide the following documents (please DO NOT include Social Security numbers on your forms). Incomplete applications will be denied until all documents are received*

Vehicle RegistrationValid Drivers LicenseProof of InsuranceProof of income (last 3 months or last year's tax return)Copy of DD214 (if you're a Veteran)
File Upload

Cancelof
I certify that the information on this form is accurate and complete. I authorize Fit It

Forward to verify the information provided.
Signature (Electronic Signature accepted)

Clear
Applicant Signature*
Date

MonthDayYear
Date
Should be Empty:

200% of Federal Poverty Guidelines 2025

Car Repair Assistance Application: