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Critical Home Repair Pre-Application

IMPORTANT: OUR CRITICAL REPAIR PROGRAM is temporarily paused while we transition staffing. Check back September 15th for an update. Thank you for your patience.

If you require assistance with a critical repair for your home, please complete this pre-application form to determine your eligibility.

Once your application is received, a staff member will contact you within 72 hours.

Learn more about the program, process, and eligibility requirements here.

If you need assistance filling out the form, please contact our Family Resources Director at info@habitatclallam.org or call (360)775-3740.

After shot of deck repair for rotted deck.

Please read all questions carefully and complete the entire application.

This information will not be shared with anyone outside of Habitat Clallam’s Critical Home Repair Department.

Applicant Information

Applicant Name(Required)

First Last

Applicant Birthdate(Required)

MM slash DD slash YYYY

Do you have a co-applicant?(Required)

Yes

Co-Applicant Name(Required)

First Last

Co-Applicant Birthdate(Required)

MM slash DD slash YYYY

Contact Information

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Repair Information

Please describe the repair(s) needed:(Required)

Please upload any photos of needed repairs:

Drop files here or

Accepted file types: jpg, gif, jpeg, png, pdf, Max. file size: 5 MB, Max. files: 20.

Gross Household Annual Income

Please estimate your gross household income In USD ($) per year. The total should include all adults listed on your mortgage.(Required)

Please enter the total number of people in your household.(Required)

How many children under 18 are in your household?(Required)

How many seniors (65 or older) are in your household?(Required)

Is anybody in your household an active member of the military?

Yes

Is anybody in your household a veteran?

Yes

Is anybody in your household disabled?

Yes

Residence Information

Do you have a mortgage?

Yes

Do you have homeowner's insurance?

Yes

Are your property taxes paid to date?

Yes

What year was your house built?

What type of home do you have?

Traditional Single Family Home

Duplex

Third Condo/Townhouse

Manufactured

Mobile

Willingness to Partner

To be considered for the program, you and your household members must be willing to partner with our organization. Each adult in your household is considered a program participant who is required to complete program requirements. This includes applicants and any person over the age of 18 at the time of the application.

This is what is called “sweat equity”. Each applicant must contribute 8 hours minimum.

Sweat equity does not necessarily mean construction-type work. It can be accomplished through admin or other volunteering opportunities.

Are you willing to partner?(Required)

Yes

Information for Monitoring Purposes

Please read this statement before Completing the following questions:

The following information is requested by us to use in our reporting and for tracking purposes. You are not required to furnish this information but are encouraged to do so. The law provides that we do not discriminate on the basis of this information, nor on whether you choose to furnish it or not.

What is your gender?

Female

Male

Non-binary

What is your ethnicity?

What is your marital status?

How did you hear about the program?

Please enter any other repair programs you have applied to:

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If you need help with this form

If you need assistance, please contact our Family Resources Director at: info@habitatclallam.org or call (360)775-3740.

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Name(Required)

First Last

Email(Required)

Tell us about your areas of interest:

Construction Projects

Client Stories

Upcoming Events

Best Ways To Help

General Info

About Us

Habitat for Humanity of Clallam County is an equal opportunity housing provider.

We are pledged to the letter and spirit of the law and provide a program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status or national origin.

Habitat for Humanity of Clallam County is a registered 501(c)3 nonprofit organization (tax ID number 91-1535386). All contributions are tax-deductible.

Donation Hotline: (360) 775-3744

Critical Home Repair Pre-Application

If you require assistance with a critical repair for your home, please complete this pre-application form to determine your eligibility.

Once your application is received, a staff member will contact you within 72 hours.

Please read all questions carefully and complete the entire application.

Applicant Information

Contact Information

Repair Information

Gross Household Annual Income

Residence Information

Willingness to Partner

Information for Monitoring Purposes

If you need help with this form

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