HHFH Home Preservation - Basic Home Repair

Home Preservation - Basic Home Repair (Aging in Place), is a Housatonic Habitat for Humanity program for Seniors, Veterans and people who are ability challenged and on a fixed income.

To be eligable to participate in this program, homeowners must provide supporting documentation of:

Must provide proof of total household income which includes but is not limited to any income from pensions, 401k's, Social Security, SSI, Medicaid, HUSKY in the form of two of your most recent bnk statements, and your latest tax return*.
If you or anyone in your household are currently employed, please provide the two most recent pay stubs for each household member.*
Excluding home equity, total household income or asset level cannot exceed $6,000 monthly or $72,000 yearly.
Must provide copy of current homeowner's insurance declaration pages.*
Home must be located in one of the vollowing CT towns: Bethel, Bridgewater, Brookfield, Danbury, New Canaan, New Fairfield, New Milford, Redding, Ridgefield, Roxbury, Sherman, Washington, Wilton and Weston.

*Before submitting proof of income, and homeowner's insurance, please block out any sensitive information such as account numbers, social security numbers and account numbers.

Please submit the documents listed above to: Housatonic Habitat for Humanity, 51 Austin Street, Danbury, CT 06810, Attn: Anne-Marie

Please note: Renters are not eligible to participate in this program.

Your Contact Information

First Name *

Last Name *

Email

Gender

Marital Status

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

State/Province

Zip *

Postal Code

Country / Region

A Couple fo Questions

Did you serve in the United States Armed Forces? * The field Did you serve in the United States Armed Forces? is required.

Did anyone in your family serve in the military? * The field Did anyone in your family serve in the military? is required.

How did you hear about this program? * The field How did you hear about this program? is required.

Number of people in your household: * The numeric field Number of people in your household: is required.

Total household income (for ALL family members) * The numeric field Total household income (for ALL family members) is required.

Home Repairs or ADA Modifications Needed

For Basic Safety:

For Safety Enhancement:

For Accessibility

For Weatherization

Media Release and Partnership Agreement

Home Preservation - Basic Home Repair (Aging in Place) Homeowner Media Release & Partnership Acknowledgement Agreement

As a prospective homeowner for our Home Preservation - Basic Home Repair Program, partnering with Housatonic Habitat for Humanity (“Habitat”) and Habitat for Humanity International, I understand and acknowledge that my story is a powerful tool to inspire, educate, and engage the community.

By signing below, I commit to partnering with and hereby grant Housatonic Habitat for Humanity (“Habitat”) and Habitat for Humanity International, along with their partners, affiliates, contractors, agents, media representatives, and assignees, the irrevocable and unrestricted right and permission to take photographs, video recordings, audio recordings, and/or written or oral testimonials of me and/or my partner/spouse, and to use such content for any lawful purpose.

I understand and agree that these materials will be used to:

Advocate for affordable housing, critical home repairs, and safe living conditions for seniors and veterans
Raise awareness of Habitat’s impact
Encourage volunteerism and financial and gift-in-kind donations
Attract future new homeowners by helping others connect to my experience

These materials may appear in:

Print publications, brochures, flyers, signage, event displays, and other marketing materials that support our mission
Online platforms, including Habitat’s website(s) and email communications.
Social media platforms, including but not limited to Facebook, Instagram, LinkedIn, and YouTube.
Press releases shared with or picked up by local/national media (TV, radio, online and print).
Fundraising campaigns, grant proposals, reports, and event presentations.

As part of my partnership with Habitat, I understand that:

I will be asked to participate in interviews, provide written or video testimonials, and complete a post-project survey.
My feedback, story, and likeness will be used in full or in part, in edited or unedited form, indefinitely.
This participation is critical to the support of Habitat’s mission to serve more families and strengthen the community.

I waive any right to inspect or approve the final use of these materials and understand that I will not receive compensation for their use. I hereby release and hold harmless Housatonic Habitat for Humanity and Habitat for Humanity International, and those acting on their behalf, from any liability relating to the use of such materials, including claims for libel, invasion of privacy, or misrepresentation.

Consent and Acknowledgement

I understand that by submitting this application, I am authorizing Housatonic Habitat for Humanity to evaluate my need for Home Preservation - Basic Home Repair or ADA modifications.

Please confirm the following in the dropdown list below.

I understand this evaluation will include personal visits.
I understand this evaluation will include income verification.
I understand that by submitting myself and all persons listed to a background check by Housatonic Habitat for Humanity.
I confirm that my answers are truthful to the best of my knowledge.
I understand that Housatonic Habitat may contact me at the email or phone I provided.
I understand that submitting this form does not guarantee program assistance.
I understand that I must submit the required documents listed in the program description, in order to be considered for this program.
I Understand and agree to the terms in the Home Preservation - Basic Home Repair Homewoner Media Release & Partnership Acknowledgement Agreement.

1. I understand there will be a home visit. * The field 1. I understand there will be a home visit. is required.

2. I understand HHFH will verify my income. * The field 2. I understand HHFH will verify my income. is required.

3. I understand HHFH will do a background check. * The field 3. I understand HHFH will do a background check. is required.

4. I confirm my answers are truthful. * The field 4. I confirm my answers are truthful. is required.

5. I understand HHFH will contact me. * The field 5. I understand HHFH will contact me. is required.

6. I understand this doesn't guarantee assistance. * The field 6. I understand this doesn't guarantee assistance. is required.

I will provide the necessary documents to HHFH * The field I will provide the necessary documents to HHFH is required.

3. Are you willing to partner with HHFH? * The field 3. Are you willing to partner with HHFH? is required.

Electronic Signature

By typing your name below, you acknowledge that it serves as your electronic signature and indicates that you have read, understood, and agree to the terms of the Home Preservation - Basic Home Repair program.

Electronic Signature (your full name): * The field Electronic Signature (your full name): is required.

Today's Date * The date field Today's Date is required.

Document

If you would like a copy for your records, please click the link below to download and print a copy of the Volunteer Agreement, Release and Waiver of Liability and Media Release.

Basic Home Repair Homeowner Agreement & Media Release and Waiver.pdf