Home Repair Interest Form

Reasons you do not qualify:
PLEASE NOTE:
Home repair applications are currently closed. By completing the questionnaire below, applicants can join the interest list and receive updates when applications reopen.
Name

First NameLast Name
Email
example@example.com
Street Address
Street Address Line 2
City
State
Zip Code
Please enter your zip code:
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is your preferred language?

Other
Do you live in the City and County of Denver?
Do you own and live in your home?
Do you own a single-family home or a townhome?
Does your home need critical exterior repairs such as: windows, doors, gutters, downspouts, siding and trim, fences, wheelchair ramp, or roof?
Are you current on ALL mortgage payments and property taxes?
Do you currently have an active homeowner’s insurance policy?
Has your home previously been repaired by Habitat Metro Denver?
When

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Is your gross monthly household income within our income guidelines? (Please see chart below.)