Do you own the home where work is to be done?
Is this your primary residence?
Is anyone in the home disabled?
Is anyone in the home a veteran?
Do you have a reverse mortgage?
Do you pay a mortgage on your home?
Does your monthly payment include property taxes and homeowner's insurance?
Do you currently have insurance on the home?
I understand that by submitting this intake, I am authorizing Habitat for Humanity of Clallam County to evaluate my need for the home repairs. I understand that the evaluation will include a home assessment by Habitat's representatives. I give permission for photos to be taken of my home. I have answered all of the questions on this form truthfully. I understand that if I have not answered the questions truthfully, my request may be denied and that even if I have already been selected to receive a Habitat repair, I may be disqualified from the program. The original or a copy of this form will be retained by Habitat for Humanity. I hereby authorize Habitat for Humanity of Clallam County to conduct credit and/or other background checks in conjunction with this request for service.