• Critical Home Repair Application

  • Please Note:

    • To be eligible for this program, you must meet the following criteria:
      • Be a current GoochlandCares clients
      • Be a Goochland County resident
      • Own the home or have legal lifetime rights to the property
      • Not be at risk of losing the property
      • Be current on Goochland Real Estate taxes
    • The Application Period will be open from January 5 through January 30 and June 1 through June 26.
    • Submitting an application does not mean automatic approval.
    • Once the application period closes, all applications will be reviewed.
    • All sections must be completed for processing. 
    • Please also submit the following documents with your application:
      • Current mortgage statement (if applicable)
      • Copy of legal lifetime rights (if applicable)
      • Copy of homeowner’s insurance (if applicable)

  • General Information

  • Format: (000) 000-0000.

  • Household Information

  • Do you own the home?*
  • If no, do you have legal lifetime rights?
  • Do you have a mortgage payment?*
  • If yes, are you mortgage payments current?
  • Do you pay Goochland County Real Estate Taxes?*
  • If yes, are you current on your payments?
  • Out of those individuals, how many of the following are:*
    Rows

  • Please fill out the following information if you would like to name someone who is authorized to discuss or make decisions regarding your home repairs. Due to our confidentiality policy, GoochlandCares cannot communicate with any individual (s) who are not listed as an authorized contact. Written consent is required to share information with anyone other than the applicant. This person must also be over the age of 18 years old. 

  • Format: (000) 000-0000.

  • Requested Repairs

  • Please list the repairs below:*
    Rows

  • Homeowner Responsibilities

  • Please read the statements below and choose an option. As the homeowner, you will:

  • Provide a reliable phone number.*
  • Maintain timely communication with GoochlandCares, the contractors, and/or volunteers. If there is no response withing one (1) week of multiple attempts, your application will be removed from the active list, and you will have to restart the application process. *
  • Be at home when GoochlandCares staff, contractors, and/or volunteers come for scheduled appointments. This includes the home inspection conducted by the Critical Home Repair Coordinator and/or volunteer, any contractor estimates, and/or work being completed. I understand not being home may result in the delay of the home repair process or the possible denial of the application.*
  • Delays or inconveniences may occur due to factors such as scheduling conflicts, weather conditions, or unforeseen circumstances.*
  • Take reasonable steps to ensure the work area is clear of household obstructions, including securing of pets to help maintain a safe and accessible environment for GoochlandCares staff, volunteers, and/or contractors.*
  • Remove or protect household items in areas where they may be subject to dust, vibrations, or damage.*
  • Failure to comply with the above responsibilities may result in the denial of the application.*
  • Agrees to participate in brief outcome survey upon the completion of the home repairs, and again in six (6) monthes after the project is complete.*

  • Authorization and Release

  • Please read and acknowledge the following statements:

  • I authorize GoochlandCares to make repairs and improvements to my property.*
  • I understand that a GoochlandCares staff member and/or volunteer will visit my home to inspect my requested repairs before any work begins, and I agree to provide reasonable access to my property for the staff, volunteers, and/or contractors so they can complete the necessary work.*
  • Only repairs requested at the time of this application will be considered. Additional repairs identified by professionals or volunteers may be added with the approval of the Critical Home Repair Coordinator.*
  • I will not be eligible to apply for the any additional repairs through this program for a period of two (2) years following the completion of these repairs.*
  • GoochlandCares is not able to guarantee or provide a warranty for the materials used or the quality of the workmanship performed.*
  • GoochlandCares will communicate with me, prior to work being started, providind me with a detailed list of approved/denied repair tasks.*
  • The applicant may choose to allow GoochlandCares to use photographs of the home repairs for promotional, educational, and/or outreach purposes. These photos may be used for outreach purposes. Any identifying information, such as faces, addresses, or personal items, will be blurred or excluded from any publicly shared images. If I do not wish to provide consent for this, I must provide the Critical Home Repair Coordinator with written response. I understand that my denial of consent will not impact my eligibility for the program.*

  • Acknowledgement and Understanding

  • The undersigned applicant(s) {name}" /> hereby certify to the best of his/her knowledge that the information provided in this application is correct.   
     
    By signing below, I authorize GoochlandCares and its designated agents to verify any or all information, including this application for home repair services.  
     
    I understand that GoochlandCares may collaborate with other non-profit agencies, organizations, and companies to complete the necessary repairs. I give permission for GoochlandCares to share relevant information and coordinate with these partners on my behalf to facilitate the repair process. 

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