A Brush with Kindness Application Smart Form

A Brush With Kindness

Golden Crescent Habitat for Humanity offers home maintenance help, performing exterior projects for eligible families, through our A Brush With Kindness program. This application must be completed to determine if you qualify for our ABWK program. Please fill out the application as completely as possible and accurately as possible. All information you include on this application will be kept confidential.
We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status, or national origin.
HOME INFORMATION
Homeowner's Legal Name

First NameLast Name
Address

Street Address

County

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Date
Email
example@example.com
Years at Address
Occupation
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
ActiveReservedReserve

FINANCIAL INFORMATION
Total monthly income before taxes for the homeowner (please make sure income reflects income listed on the documents provided):
YesNo
YesNo
Please provide proof of homeowner insurance

Cancelof
Amount recieved
Fema
YesNo
YesNo
Please state how much

Requested Repairs

Please provide a detailed description of requested repairs. In the left-hand column, label each in order of importance, with 1 being the most important

Rows	Document Upload
Completed application
Verification of all homeowner income
Deed of home or other proof of home ownership and proof of homeowner insurance
Legible copy of government-issued photo ID, showing name, address, date of birth

Completed application

Cancelof
Verification of all homeowner income

Cancelof
Deed of home or other proof of home ownership and proof of homeowner insurance

Cancelof
Legible copy of government-issued photo ID, showing name, address, date of birth

Cancelof
Should be Empty:

A Brush With Kindness