Application for Repairs

Mission Devine Request for Repairs

PO Box 134 Devine, TX 78016
"Love thy Neighbor as thy self" ~ Matthew 22:36
APPLICATIONS WILL BE RECEIVED UNTIL MAY 19

Note: Only residents of Devine and Natalia Independent School Districts, and some surrounding areas, will be considered.
Project Number
Date*

MonthDayYear
Date
Name of Homeowner / Applicant*

First NameLast Name
Age of Homeowner*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Primary Phone Number*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Are you or someone living in the home a veteran?*

YesNo
Are you a widow or widower?*

YesNo
Are you or anyone living in this home disabled?*

YesNo
Do you own you home?*

YesNo
Are you currently living in this home?*

YesNo
Do you own more than one home?*

YesNo
Is this a Mobile Home?*

YesNo
Do you have property insurance?*

YesNo
Do you pay rent to live here?*

YesNo
Will you be living in this home after repairs are made?*

YesNo
Are you planning to sell this home after repairs are completed?*

YesNo
How Many people are living in the home?*
How many years have you lived in this home?*
Is this your first request with Mission Devine for work to be done at this address?*

YesNo
If Mission Devine has worked on your home before, what was done and when?
Have you spoken to a Mission Devine Committee Member already?*

YesNo
If so, please list their name
How would you like to be contacted?*

By PhoneBy email
I'm having a problem with:*

PlumbingElectricalStructuralYard / Trees
Please describe the work that needs done*
Briefly describe why you need Mission Devine to complete this work for you*
Would you agree to allow Mission Devine to take pictures of your home before and after Mission Devine work is done? (your name and address will not be published)

YesNo
Thank you for completing this application. We will make every effort to contact you. Please make and keep a copy of this application. If you have not heard back from someone with Mission Devine by June 1, 2019, call 830-931-1532 to check on the status of your application.

Mission Devine was organized by the Devine Ministerial Fellowship and is an ecumenical Christian organization that strives to show God's love by providing home improvements in a loving and compassionate way for those less fortunate in our community. We do not discriminate on the basis of race, color, religion, sex, handicap, familial status or national origin. Projects can only be approved as funding and volunteer crews are available - applications will be considered based on the applicant's need and our available resources. Any and all work will be performed during our annual work week in June.
E-Signature
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Mission Devine Request for Repairs