Rock the Block Application | Habitat for Humanity of Greater Sacramento

Rock the Block Application

- Step 1 of 5

Please note that you must be a resident of Oak Park to qualify for this program. Also, please note that you will not be able to submit an incomplete application. A complete application must include submission of this completed application and the following documents:

1. Proof of ownership of the property (most recent mortgage statement) 2. Proof of current homeowners insurance (current homeowners insurance policy declaration page) 3. Most recent tax return/tax filing for anyone over the age of 18 in the household; if you do not file taxes, please contact our office at repair@habitatgreatersac.org to discuss other options for confirming financial qualification. 4. CA Driver's License or Identification Card for anyone over the age of 18 in the household.

Name *

First

Last

Co-Owner Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Based on your zip code, your home is outside of the service area for Rock the Block - Oak Park.

To learn more about programs that you may qualify for, please click here.

Phone *

Email *

Number of Residents in home: *

Age(s) of residents (check all that apply) *

0-17 years
18-64 years
65+ years

Is the applicant the owner and a primary resident at the property? *

Is the applicant a renter? *

If applicant does not reside at the property, what is your relationship to the resident?

Is any household member a US Veteran? *

If Yes, please provide form DD214 with your application.

Drag & Drop Files, Choose Files to Upload

Does any household member have accessibility issues? If Yes, we will evaluate the home for ramp installation. *

What year was the home built? *

Do you have current homeowners insurance? *

Is this a mobile home? *

Is this a Duplex? *

Is this home in an HOA? *

Is there a Reverse Mortgage on the home? *

Do you own any other property? *

Has Habitat previously worked on the property? *

When?

What work was performed?

What type of repairs are you interested in? (Check all that apply) *

Landscaping / Yard Cleanup
Fencing
External Paint
Dry Rot
Gutter Cleaning
HVAC
Roof Replacement
Pest Abatement
Windows
Water Heater Replacement
Energy Efficiency Repairs

Other repairs (please specify)

Please tell us about the condition of your home and the needed repairs: *

Tell us about your family, and how these repairs would impact you and your family: *

Please submit the following documents with your application:

Proof of ownership of property (most recent mortgage statement) *

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Proof of current homeowners insurance (current homeowners insurance policy declaration page) *

Drag & Drop Files, Choose Files to Upload

Most current tax year filing for anyone over 18 in the household; if you do not file taxes, please email repair@habitatgreatersac.org to discuss other options for confirming financial qualifications for repairs

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

CA driver's license or other identification for anyone over 18 in the household *

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

If my property is selected as a project site, I agree to the following (intital on each line):

I will participate in the work on my property with volunteers. Those who are not physically able to help with repairs or have conflicts can participate in other assigned volunteer opportunities. *

Clear Signature

I understand that I may need to provide additional financial information and a complete loan application depending on the scope of the repair project. Further, I grant permission to Habitat for Humanity of Greater Sacramento to take any actions reasonably necessary to substantiate the information I have provided or otherwise establish my suitability as an applicant, including but not limited to a complete consumer report and background check, and Habitat may reject this application based on the results of these inquiries. *

Clear Signature

I understand that a member of the Habitat for Humanity of Greater Sacramento team will schedule an appointment with me to review the work to be done on my home and to complete a formal Homeowner Partner Agreement prior to the project. *

Clear Signature

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PLEASE READ THIS STATEMENT BEFORE COMPLETING THE BOX BELOW:

We are requesting the following information to monitor our compliance with the federal Equal Credit Opportunity Act, which prohibits unlawful discrimination. You are not required to provide this information. We will not take this information (or your decision not to provide this information) into account in connection with your application or credit transaction. The law provides that a creditor may not discriminate based on this information or based on whether or not you choose to provide it. If you choose not to provide the information, we will note it by visual observation or surname.

I do not wish to furnish this information.

Race/National Origin (applicant may select more than one racial designation)

American Indian or Alaska Native
Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Black or African American
Native Hawaiian or other Pacific Islander
Guamanian or Chamorro
Native Hawaiian
Samoan
White
Other

If Other, please specify:

Ethnicity:

Hispanic or Latino
Non-Hispanic or Latino

Cuban
Mexican
Puerto Rican
Other

If Other, please specify:

Gender

Female
Male
Non-binary/Non-Conforming
Prefer not to Respond

Birthdate

Marital Status

Married
Separated
Unmarried

Do any of the following apply to any household member(s)?

Disabled
Over 65
Under 18
Veteran

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Habitat for Humanity of Greater Sacramento Experience and Feedback:

How long have you lived in your home? *

Less than 1 year
1-5 years
6-10 years
Over 10 years

How would you describe the appearance of your neighborhood (e.g. roads, houses, yards)? *

Excellent
Good
Average
Poor

How would you describe your relationship with your neighbors? *

Excellent
Good
Average
Poor

In general, my neighborhood is a good place to live. *

Strongly Agree
Agree
Disagree
Strongly Disagree

What is your preferred language? *

If English is not your primary language, is there an English speaker who can help with the application process? *

Our organization uses a live translation service for phone calls. Would you like us to use that when we call you?

How did you hear about our program? *

Habitat Website
Social Media
Postcard
Flyer
Other media
Organization
Word of Mouth
Other

Other media type

Organization name

Word of mouth - who?

Single Line Text

Signature *

Clear Signature

Numbers

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Disclosure and Authorization for Consumer Reports

Please provide the following information for every person over the age of 18 years old living in the home.

In connection with my application for employment or promotion or other job change and/or in connection with my desire to provide volunteer services, and/or to become a home owner/family partner with Habitat for Humanity of Greater Sacramento (the Company), I understand the Company may obtain an INVESTIGATIVE CONSUMER REPORT that will include information as to my character, general reputation, personal characteristics and mode of living. This report may reveal information about work habits, including oral assessments of my job performance, experiences and abilities, along with reasons for termination of past employment. Such a report may be requested by the Company or on behalf of the Company. Further, I understand and agree that, subject to any legal restrictions imposed by any federal, state or local law, the Company may request information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my driving record, criminal record, civil matters, previous employment, educational background and professional licensing if any.

Credit reports will be ordered from:

Factual Data
5100 Hahns Peak Drive
Loveland, CO 95838
800-929-3400
www.factualdata.com

Criminal background reports will be ordered from:

Backgrounds Online
1915 21st Street
Sacramento, CA 95811
800-838-4804
www.backgroundsonline.com

You have the right, upon written request made within a reasonable period of time (not to exceed 30 days) after receipt of this notice to receive a written disclosure of the nature and scope of any investigation.

If a consumer investigative report is obtained and an adverse decision is made affecting your employment, volunteer status, or homeownership the Company will provide to you, before making the adverse decision, a copy of the investigative consumer report and a description in writing of your rights under the Fair Credit Reporting Act.

NOTICE TO CALIFORNIA APPLICANTS

You have a right to obtain a copy of any investigative consumer report obtained by Habitat for Humanity of Greater Sacramento by checking the box provided below. The report will be provided to you within three business days after the report is provided to Habitat for Humanity of Greater Sacramento.

I request to receive a free copy of this report:

Under section 1786.22 of the California Civil Code, you may view the file maintained on you by the consumer reporting agency named above during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services, by appearing at the Consumer Reporting Agency identified above in person or by mail. You may also receive a summary of the file by telephone. The agency is required to have personnel available to explain your file to you and the agency must explain to you any coded information appearing in your file. If you appear in person, a person of your choice may accompany you, provided that this person furnishes proper identification.
I acknowledge that a fax or copy of this Disclosure and Authorization bearing my signature shall be as valid as the original. This release is valid for all federal, state, county and local agencies and authorities. I acknowledge that I have received a copy of the Summary of Rights pursuant to the Fair Credit Reporting Act (FCRA).

Name *

First

Last

Phone *

Email *

Social Security Number *

Birthdate *

Signature *

Clear Signature

Please provide the following information for any additional adults over the age of 18 living in the home.

Second Adult Name

First

Last

Second Adult Phone

to there family,

Second Adult Email

Second Adult Social Security Number

Second Adult Birthdate

Second Adult Signature

Clear Signature

Third Adult Name

First

Last

Third Adult Phone

Third Adult Email

Third Adult Social Security Number

Third Adult Birthdate

Third Adult Signature

Clear Signature

Fourth Adult Name

First

Last

Fourth Adult Phone

Fourth Adult Email

Fourth Adult Social Security Number

Fourth Adult Birthdate

Fourth Adult Signature

Clear Signature

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