CHDC PROGRAMS APPLICATION

PROGRAMS APPLICATION

For all applicants applying for any CHDC home repair program
Date*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
How Many Occupants In The Home?*
Estimated Annual Household Income for all occupants?*
Referred By?
Description Of Needed Repairs:*
Problems?

If you have problems or questions with this form, please use the chat option on our website or send email to: chdcapplications@gmail.com

CHDC requires that you MUST submit the last 2 years of your federal income tax reports OR other income verification forms such as a Social Security Proof of Income Benefits letter for the last 2 years to verify income before you can be approved for any of our programs. We can not begin the application review process until we receive these items. PLEASE UPLOAD READABLE PHOTOS OR COPIES NOW. Are you on a computer where you can upload your tax documents now?

Yes, I can upload my tax documents or Social Security benefits letter now.No, I will have to email or mail them later and I understand that this may delay my application. Please email to chdcapplications@gmail.com

File Upload of Previous Year 1 Tax Document

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File Upload of Previous Year 2 Tax Document

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CHDC requests photos of the problems in need of repair on your home. This can speed up the review process. CHDC will do a site visit to confirm any needed repairs. Do not attempt to take photos while on a ladder or on top of your roof. Any photos should be taken from ground level only. Are you on a mobile phone with a camera and would like to take photos now?

I am on a mobile phone and can take photos now.I am on a computer and can upload photos now.No, I will email them to chdcapplications@gmail.com and I understand that this may delay my application.

Take Photo 1
Take Photo 2
Take Photo 3
Take Photo 4

Upload Photo 1

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Upload Photo 2

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Upload Photo 3

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Upload Photo 4

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CHDC requires that you MUST submit two (2) forms of identification with at least one (1) being a VALID state issued photo ID for the state in which you reside and the second (2) being a utility bill or something similar. We can not begin the application approval process without these 2 items. PLEASE take a take a PHOTO or UPLOAD READABLE PHOTOS OR COPIES NOW. How would you like to submit your two (2) forms of ID?

I am on a mobile phone and can take photos now.I am on a computer and can upload copies or photos now.I will email copies or photos to chdcapplications@gmail.com and I understand this may delay my application.

Take Photo 1
Take Photo 2

Upload Photo 1

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Upload Photo 2

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RELEASE OF ALL CLAIMS

For All CHDC Programs

This Release is executed in City* State* on this day Date* , by First Name* Last Name* on behalf of myself and my heirs, executors, administrators, representatives, and assigns, hereinafter referred to collectively as Releasors.

Releasors warrant and agree that they are the fee simple title owner(s) of the following property, subject only to the Exceptions of Conveyance and Warranty:

Street Address* City* State* Zip*

Releasors further warrant and agree that they are aware and understand the scope, parameters, and requirements of the CDHC Raise the Roof Program or other CHDC programs they are requesting help from and Application, incorporated herein by reference with the same force and effect as though fully set forth herein.

In consideration of installation of a new shingle roof through Crossroads Housing Development Corporation’s (CHDC) Raise the Roof Program and/or other repairs made to the above referenced property, Releasors, for themselves, their heirs, executors, administrators, representatives, and assigns, hereby release, waive, discharge and covenant not to sue, Crossroads Housing Development Corporation, as well as their officers, directors, partners, representatives, employees or agents of any description, all of whom are referred to as Releasees, from any and all liability, claims, injuries, damages and causes of action in any way related to the Raise the Roof Program and work performed or materials used by any roofing contractor, whether or not such claim is the result of the negligence of any of the Releasees. Releasors agree to indemnify and hold Releasees harmless from any and all such claims, injuries, damages and causes of action brought by, through or under Releasors.

Releasors state that they have carefully read the above and foregoing release, understand it, and sign it of their own free will.

This release contains the entire agreement between the parties to this agreement and the terms of this release are contractual and not a mere recital.

Releasors also acknowledges that this release or the application incorporated herein is not an approval or guarantee that work or repairs will be provided.
By signing below I further acknowledge and agree to the Release of All Claims above.*
IMPORTANT NOTE:

The CHDC requirement for you to submit any documentation that we require is 30 days. It is not the responsibility of CHDC to obtain these documents from you. It is the responsibility of the applicant (you) to provide CHDC with the required documents within 30 days of the date of your application. If the required documents are not submitted within 30 days, then you are at risk of CHDC discarding your application. If that happens then you must re-submit your application with the required documentation (items 7 & 8 above). THERE ARE NO EXCEPTIONS TO OUR POLOCIES.
Should be Empty:

PROGRAMS APPLICATION

Problems?