• HopeWorks Home Repair Assistance Application

  • HopeWorks helps widows and income-eligible seniors age 60 and older remain safely in their homes through gas furnace and gas water heater repair or replacement, small home repairs when funding is available, and compassionate care anchored in the love of Christ.
     
     Estimated completion time: 10–15 minutes.

    Please have proof of income for all household members ready. If you are requesting furnace or water heater assistance, please also have a recent natural gas bill.

    Submitting an application does not guarantee assistance. Eligibility, available funding, inspection results, and the scope of work must be confirmed.

    Our Commitment: HopeWorks serves all eligible applicants with dignity, fairness, and respect, without discrimination based on race, color, creed, religion, national origin, sex, age, disability, or any other status protected by law. Participation in religious activities is voluntary and is not required to receive services.

    Need more time or documents? Select Save and Finish Later to receive a secure link that allows you to return to your application.

  • 404-872-0167 ext 1 | intake@hopeworks4us.org | 751 Rice Street NW, Atlanta, GA 30318

  • Applicant and Contact Information

  • Are you completing this application for yourself or on behalf of the homeowner?*
  • Format: (000) 000-0000.
  • Are you completing this application under a valid Power of Attorney for the homeowner?*
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Applicant Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Preferred Contact Method*
  • Best Time to Contact You
  • Text Message Consent*
  • Do you own and live in this home?*
  • Do you own any other properties?*
  • Do you own and live in this home?

  • Homeownership and Household

  • Whose name(s) are on the deed?*
  • Are you the legally authorized representative?
  • Whose name(s) are on the deed?
  • Is Power of Attorney involved?
  • Citizenship/Residency
  • What is your current marital status?*
  • What is your current marital status?
    • Household, Eligibility, and Repair Details 
    • Citizenship/Residency*

    • Income and Eligibility

    • Repair Request

    • What needs repair? Select all that apply.*

    • Age eligibility for furnace and water-heater assistance varies by program and funding source. Some programs serve homeowners age 60 and older, while others require homeowners to be age 65 or older. Applicants must also own and live in the home, meet applicable income guidelines, and have qualifying natural gas service.

    • What is the homeowner’s age range?*
    • Is natural gas service currently active at this property?*
    • Is this property within the Atlanta Gas Light service territory?*
    • Based on the date of birth entered, the homeowner does not meet HopeWorks’ minimum age requirement of 60. This application cannot continue. If you believe this is an error, please contact HopeWorks at 404-872-0167 ext. 1.
    • Does the requested system or appliance use natural gas?
    • Natural Gas Marketer (as listed on your bill)

    • If you smell gas or believe there is an active gas leak, leave the area immediately. From a safe location, call 911. Do not wait for HopeWorks to respond.

    • Has HopeWorks ever serviced this home?*
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Has a contractor or technician told you that additional prerequisite work is needed before the furnace or water heater can be repaired or replaced?

    • Required Documents

    • Has HopeWorks ever serviced this home?
    • Do any of the following apply to the property or request? Select all that apply.*
    • Your application may require additional review. Please continue and provide relevant details.
    • Do any property, insurance, ownership, legal, or contractor-safety concerns apply to this request?*
    • Which concerns apply? Select all that apply.
    • Are you able to upload your documents now?*
    • Supporting Documents Upload each document in the clearly labeled place below. Proof of income may include multiple files for all adults in the home. 

    • You may still submit this application. HopeWorks will contact you about providing documents. You may also call 404-872-0167 ext 1 or email intake@hopeworks4us.org for assistance.

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Please confirm that NONE of the following apply to your situation:*
    • Privacy Notice: HopeWorks collects the information and documents in this application to evaluate eligibility, verify program requirements, coordinate services, and meet applicable funding and reporting obligations. Information will be accessed only by authorized HopeWorks personnel and approved program partners as needed to process the request and will not be sold.

    • HopeWorks Non-Discrimination Statement

      HopeWorks is a Christ-centered nonprofit organization committed to treating every person with dignity, fairness, and respect. No otherwise eligible applicant or participant will be excluded from participation in, denied the benefits of, or treated differently in connection with HopeWorks services because of race, color, creed, religion, national origin, sex, age, disability, or any other status protected by applicable law. Participation in prayer, worship, or any other religious activity is entirely voluntary and is not required to apply for or receive services. Service decisions are made consistently according to HopeWorks’ established program eligibility requirements, geographic service area, available resources, and the nature and urgency of the requested work.
    • Program(s)
    • Intake and Eligibility Status
    • Ready for Operations
  • Should be Empty: