Critical Repair Program- Veazey Area

Critical Repair Program- Veazey Area

This application is for homeowners who live in the highlighted areas in the Veazey neighborhood:
Do you live in the 70501 zip code in Lafayette, LA?*

YesNo
Do you live in the Frank St. area? (See highlighted area of above map.)*

YesNo

Critical Home Repair Program

This is an application for Lafayette Habitat for Humanity's Critical Home Repair Program. Please complete this application truthfully, completely, and accurately and upload ALL required documentation. Failure to submit all required documentation will cause processing delays. All information you include on this application will be maintained in accordance with our privacy policy.

We are pledged to the U.S. policy for the achievement of equal housing opportunity. We support an affirmative advertising and marketing program in which there are no barriers to obtaining housing services because of race, color, age, religion, sex, handicap, marital or familial status, income source, national origin, sexual preference, or exercising the right to federal credit protection.

APPLICANT INFORMATION

The Applicant(s) must be the owner of the home in need of repair and occupy the home as their principal residence. If more than one person is on the home's deed, they are considered a co-applicant and their information will be requested later in the application.

In order to electronically submit your application, you will need to give your consent to electronically sign your application. Please check the box below to proceed with the electronic application and signature. If you do not wish to complete the electronic application, you may pick up a physical copy at our main office located at 823 W. Congress St., Lafayette, LA or call (337) 261-5041 to request a copy be mailed to you.

Household Information

Please tell us who lives in the home with you.
Does anyone else live with you in your home?*

YesNo
Please list the names of all people who live with you in your home. *

Asset Verification

In order to qualify for the Critical Repair Program we require that you tell us about your assets.
Do you or your co-applicant (if applicable) have any of the following assets? (check all that apply)*

Bank Account (Checking)Bank Account (Savings)Other homes or real property besides your primary homeCashStocksRetirement/401K/IRANone of the aboveOther assets
What is the value of your checking account?*
What is the value of your savings account?*
What is the value of your other homes or real property?*
What is the value of the cash that you currently have?*
What is the value of your stocks?*
What is the value of your Retirement/401K/IRA?*
Please tell us about your other assets in the box below.*

Income Verification

In order to qualify for the Critical Repair Program we require that you tell us about your income.
Please fill in the chart below for ALL household members and sources of income. You will be asked to upload documentation to verify this information later in this application. *
Are there any special circumstances regarding your household income or expenses that you believe we should be made aware of (such as home health care, hospital cost, medication expenses, etc.)?

Applicant History
Have you ever applied to Lafayette Consolidated Government for the major/ minor program?*

YesNo
If yes, when? *
Have you ever applied to Rebuilding Together Acadiana?*

YesNo
If yes, when? *
Has Rebuilding Together Acadiana or Lafayette Consolidated Government ever done work on your home?*

YesNo
If yes, when and what type of repairs were completed? *

Types of Repairs to be Considered
What type of repairs would you like to be considered for?*

ElectricalPlumbingExterior PaintingCarpentry RepairsFloor RepairsRoof RepairsOther
Tell us about the condition of your home and how you could benefit from Lafayette Habitat's Critical Repair Program. *

Document Upload

Lafayette Habitat for Humanity REQUIRES documentation of ALL sources of income for each household member. Please upload files in the designated area below:

Failure to provide this information may result in denial of your application. If you are unable to upload documents, you may bring copies to the Lafayette Habitat for Humanity office located at 823 West Congress Street, Lafayette, LA 70501. This information must be received in our office by the application deadline.
PRIMARY & CO-APPLICANT: Please upload copies of your driver's license or state issued ID.

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PRIMARY & CO-APPLICANT: Please upload a copy of your Social Security card.

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PRIMARY & CO-APPLICANT: Please provide documentation for all employment from the last three months.

i.e.: paystubs and/or proof of earnings if self employed.
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PRIMARY & CO-APPLICANT: Please upload a copy of your most recent W-2 and/or 1099 form(s).

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PRIMARY & CO-APPLICANT: Please upload a copy of your most recent Federal Tax Return.

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PRIMARY & CO-APPLICANT: Please upload a copies of your most recent checking account statement(s) for ALL accounts.

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PRIMARY & CO-APPLICANT: Please upload a copies of your most recent savings account statement(s) for ALL accounts.

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PRIMARY & CO-APPLICANT: Please upload other income documents.

i.e.: TANF, Alimony, Child Support, Social Security, SSI, Disability, Unemployment Benefits, VA Compensation, Retirement (e.g. pension), Military Entitlements, SNAP/Food Stamps, Other Monetary Contributions (e.g. money from family/friends/acquaintances)
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Do you need to add files for other household members?*

YesNo

OTHER HOUSEHOLD MEMBERS: Please upload a copy of the social security cards of other household members that will live with your in the home.

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OTHER HOUSEHOLD MEMBERS: Please upload a copy of the driver's license or state issued ID of all adult household members that live with you in the home.

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OTHER HOUSEHOLD MEMBERS: Please provide documentation for all employment from the last three months.

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OTHER HOUSEHOLD MEMBERS: Please upload a copy of your most recent W-2 and/or 1099 form(s).

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OTHER HOUSEHOLD MEMBERS: Please upload a copies of your most recent checking account statement(s) for ALL accounts.

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OTHER HOUSEHOLD MEMBERS: Please upload a copies of your most recent savings account statement(s) for ALL accounts.

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OTHER HOUSEHOLD MEMBERS: Please upload other income documents:

TANF, Alimony, Child Support, Social Security, SSI, Disability, Unemployment Benefits, VA Compensation, Retirement (e.g. pension), Military Entitlements, SNAP/Food Stamps, Other monetary contributions (e.g. money from family/friends/acquaintances)
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Veterans ONLY: Form DD214

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Homeowner Agreement
I understand that by filing a Critical Repair Program application with Lafayette Habitat for Humanity, I am authorizing Lafayette Habitat for Humanity to evaluate my need for home repairs, to determine my ability to qualify for LCG’s forgivable loan, and to verify the information submitted in my application. I understand that the evaluation may include, but is not limited to, personal visits (by appointment), home inspections (by appointment), credit checks, employment verification, and sex offender registry checks.

I certify that the information I have submitted on this application is accurate and complete, that I/we own the home at the address given on this application, and that I have no present intention to move or offer my home for sale within the next 2 years. I understand that if any of the information I submitted is found to be false or incomplete, my application may be denied, even if I have received initial approval to participate in the program.

The original or a copy of this application will be retained by Habitat for Humanity even if the application is not approved.

By signing this statement I am submitting to such inquiries, allowing the release of my personal information to Lafayette Habitat for Humanity, and certifying that all information submitted on this application is accurate and complete.
Signature*

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Co-Applicant Signature*

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Interest Form

At this time we are only working in the Frank St Area. However, if you would like us to keep your information on file for future projects, please tell fill out the information below so we can stay in touch. Thanks!
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing address different from your physical address?

YesNo
Mailing Address, if different

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell Phone*
Please enter a valid phone number.
Home Phone*
Please enter a valid phone number.
Do we have your permission to send you occasional text messages with updates?*

YesNo

I certify that all information entered is accurate and I would like to submit my application.

Yes
Should be Empty:

Critical Repair Program- Veazey Area

Applicant Information

Homeownership Verification

Household Information

Asset Verification

Income Verification

Special Needs/ Disabilities

Applicant History

Types of Repairs to be Considered

Homeowner Agreement

Interest Form