Rock the Block West Sacramento Home Repair Application | Habitat for Humanity of Greater Sacramento

Rock the Block West Sacramento Home Repair Application

- Step 1 of 4

Please note that you must be a resident of West Sacramento 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 - West Sacramento.

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.

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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) *

Drag & Drop Files, Choose Files to Upload

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

please If 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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