• HopeWorks Home Repair Assistance Application

  • HopeWorks helps widows and income-eligible seniors remain safely in their homes through critical repairs and compassionate care, anchored in the love of Christ. Estimated time: 10–15 minutes. Please have proof of ownership and proof of income for every adult in the home. If you are requesting furnace or water-heater assistance, please also have a recent natural gas bill. Submission does not guarantee assistance; eligibility, funding, inspection, and scope 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.

  • 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?*
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  • Applicant Date of Birth*
     - -
  • 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 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*

    • 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?*

    • Eligibility review notice: One or more answers may fall outside the program’s standard eligibility. You may still submit for staff review or call 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?*
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    • 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?*

    • Documents, Authorization, and Signature

    • 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.

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    • Please confirm that NONE of the following apply to your situation:
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    • 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.
    • Natural Gas Marketer (as listed on your bill).*
  • Should be Empty: