Habitat for Humanity Portland Region
Home Repair Application

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Welcome to Habitat for Humanity Portland Region's online application for the Home Repair Program. 

The application will ask you for personal information about yourself, your finances and your household. Please be prepared with the following information:

1. Household Information: Birth dates, employment and demographic information

2. Economic Profile: Household income, including assistance and spousal or child support

3. Property Information: Mortgage and insurance information

4. Repair Request Details: What needs to be repaired on or in your home? 

5. Power of Attorney or Legal Guardianship Information

Please be prepared to attach the following documents to your application:
  • Copy of homeowners insurance policy declaration page 
  • Copy of most recent mortgage statement (if applicable) 
  • Copy of driver’s license or government issued photo ID for applicant and co-applicant 
  • Copy of most recent federal tax return for applicant and co-applicant
  • Income documentation such as a benefits award letter, paystubs, or pension/retirement documentation for all household members.
  • Copies of all documents should be clear, bright and easy to read.

Please reach out to homerepair@habitatportlandregion.org with questions or if you would like to receive a paper copy of this application by mail instead of completing it electronically. 

Save
Click the "Save my progress and resume later" link at the top of any page. You'll be prompted to submit an an email and password.  Afterwards, you'll receive an email with a link that can be used later to open the application and continue working. When you return to complete the form, you will need to provide the same email and password.

Tip: If your internet connection is inconsistent, save your progress as you go.


Submit
All required fields must be filled. Any left blank will be highlighted in red when you attempt to submit. 
Fair Housing Act (42 USC 3600, et seq.)
If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)
Primary Applicant Information



MM/DD/YYYY

Power of Attorney or Guardian Details
Share the full name and contact information for the person who has Power of Attorney for or is the legal guardian of the applicant.
This person will need to sign this application.




Please use this format: 555-555-5555

Please note: Habitat only conducts repairs on owner-occupied homes.





Note: these race categories are defined by HUD and are not all-inclusive. Please select the option or options that resonate with you most.








If you do not have an email address, please call us at 503.287.9529 ext. 1336 so we can mail you a paper application.


Please use this format: 555-555-5555

Please use this format: 555-555-5555


Please use this format: 555-555-5555

Is there a Co-Applicant?
Please note: anyone listed on the property title must be listed as an applicant or co-applicant.

Co-Applicant



MM/DD/YYYY


Co-Applicant Power of Attorney or Guardian Details
Share the full name and contact information for the person who has Power of Attorney for or is the legal guardian of the Co-Applicant.
This person will need to sign this application.




Please use this format: 555-555-5555


If you do not have an email address, please call us at 503.287.9529 ext. 1336 so we can mail you a paper application.

Please use this format: 555-555-5555



Note: these race categories are defined by HUD and are not all-inclusive. Please select the option or options that resonate with you most.





Additional Information





Fair Housing Act (42 USC 3600, et seq.)
If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)
Property Information:
Please note:
  • Please only include information about the property for which you are applying for repairs.

  • HFHPR is only able to provide repair services to homeowners living in Oregon, within the zip codes in our service area. If you do not see your zip code listed below, we may be unable to provide repair services to your home. 

List the address of the property you are apply for repairs on.






HFHPR's Repair program only works on homes that are both owner-occupied and the applicant's primary residence.

Input numbers only. Ex: 2200

If you are 90 days behind or more, please select "no". Otherwise, select "yes". Homeowners must be current on their mortgage and not in the foreclosure process to qualify for HFHPR's repair program.


Input numbers only. Ex. 200

Homeowners must be current on their property taxes or enrolled in a payment plan with the county.


Homeowners must have and maintain homeowner's insurance to qualify for HFHPR's repair program.


Input numbers only. Ex. 200


Input numbers only. Ex. 200




Repair Needs

2. Household Information

Please provide information on any other members of your household, such as children, grandparents, or other adults in the household who are full time or part time residents. This information helps calculate your household size. Demographic information is not a criteria in the approval process but provides a clearer picture on the types of families who might benefit from affordable home repair opportunities.

Default recommendation is to enter individual Household Members (you can un-require fields as needed). If using Household Size, individual household members still must be created to accurately calculate AMI. Use Skip logic (consult Lincoln Parkway Consulting)

Additional Household Member




MM/DD/YYYY

Optional Demographic Information


Note: these race categories are defined by HUD and are not all-inclusive. Please select the option or options that resonate with you most.




Fair Housing Act (42 USC 3600, et seq.)
If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)
3. Economic Profile
Income Sources
Please read the instructions closely.
Add each income source for all household members over the age of 18 below.

If someone in your household is over the age of 18 and is not currently working, we will send you a Certificate of Zero Income form after you apply. A Certificate of Zero Income form is required for all household members over 18 and not currently earning any income or receiving any benefits.

Sources of income include earned income from employment as well as benefits, social security and child support. If you have multiple sources of income, use the "Add Another Applicant Income Source" link to add as many as you need

Default recommendation is to use real Income Sources. If using Annual Only, Hide Income Source fields and adjust Connector to create a single placeholder Income Source, Other, with this amount).


Applicant Income Source


Only include numbers (Ex. 45000). No special characters or commas.

MM/DD/YYYY





Please use this format: 555-555-5555



Co-Applicant Income Source


Only include numbers (Ex. 45000). No special characters or commas.

MM/DD/YYYY





Please use this format: 555-555-5555


Other Household Member Income Source




MM/DD/YYYY





Please use this format: 555-555-5555

Required Documents
Please upload the following required documents:
  • Copy of your most recent real property tax statement 
  • Copy of your homeowners insurance policy declaration page 
  • Copy of your most recent mortgage statement (if applicable) 
  • Copy of your driver’s license or government issued photo ID for applicant and co-applicant 
  • Copies of your most recent federal tax returns
  • Relevant income documents for all household members over 18. See below for income documents required, depending on situation:
If you/the household member have are consistently employed:
  • Copies of 2 months of most recent pay stubs.
    Note: We need 2 months of paystubs regardless of how often you are paid.
If you/the household member has inconsistent or seasonal employment:
  • Copies of 2 months of most recent pay stubs
    Note: We need 2 months of paystubs regardless of how often you are paid.

  • Completed employment verification form confirming your seasonal, on-call, or other employment status.

  • Copies of most recent W2s and/or 1099s.

If you/the household member is self-employed:
  • Current profit and loss statement reflecting income and expenses through at least the end of the most recent quarter.

  • Copies of Schedule C tax forms from most recent federal tax returns.

If you/the household member has other sources of income or assets:
  • Documentation of other income (examples: SSI or Social Security award letter, retirement benefits statement, veterans’ benefits statement, etc.)

  • Documentation of assets (example: proof of ownership of a second property).
If you/the household member has zero income:
    • After submitting your application, email homerepair@habitatportlandregion.org to request a Certificate of Zero Income and return the form by mail or email. 

    • A Certificate of Zero Income form must be complete for each member of the household over 18 who does not earn any income or receive any benefits.
    Whenever possible, please label your documents with your first and last name and the type of document. For example: Mickey Mouse 2024 Tax Return.

    Willingness to Partner
    Selected homeowners must work with program staff by providing application materials, being in active communication, and allowing access to the home for home visits and contractors.
    I am willing to partner in the above manner with Habitat for Humanity Portland Region:


    7. Acknowledgment
    I understand that by filing this application, I am authorizing Habitat for Humanity Portland Region to evaluate my eligibility and need for the Home Repair Program. I understand that the evaluation may include home visits, a credit check and employment verification.

    I have answered all of the questions on this application truthfully. I understand that if I have not answered the questions truthfully, my application may be denied, and that even if I have already been selected to receive Habitat services, I may be disqualified from the program. I acknowledge that the original or a copy of this application will be retained by Habitat for Humanity Portland Region even if the application is not approved.








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