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By completing this application, applicants acknowledge:

I understand that submittal of this application is not a guarantee of services from RTTB.

I understand that RTTB provides home repair services free of charge to low-income homeowners; therefore, RTTB receives more applications than can actually be served with available funding.

I understand that RTTB is able to provide free home repair services based on the amount of funding they are able to raise throughout the year from public and private sources; and once funding is exhausted, applicants must wait until funding is secured.

I understand that RTTB reviews applications on a first come, first served basis, and applications may be filtered based on specific project criteria such as:

  • Availability of funding
  • Funding source and specific criteria per funder
  • Type and degree of need (safety, accessibility repairs)
  • Area or neighborhood (target neighborhoods)

I understand that my application must be complete in order to be considered.  Incomplete applications will not be considered.

I understand that once I am contacted because my home has been selected, I will need to provide documentation to verify all of the information I have provided in this application.

Proof of: 

  • Household income, all sources
  • Current homeowners insurance
  • Identification
  • Current mortgage
  • In the home for at least 2 years

In addition, I will supply the information above on all persons living in the home.

I understand that I will need to provide the above documentation to RTTB within two (2) weeks of notification in order for my home to remain on their project list.  If I cannot provide this information in a timely manner, my home may be delayed until another project cycle.

I understand that if my home is selected, I will need to be available to meet with RTTB staff for an in-home interview and home assessment(s) to determine the work to be done on my home, as well as in case case of inspections.

I understand that if my home is not selected as a project for RTTB within one year of my application date, I may reapply for services.  Applications older than one year are not considered on the active waiting list.

 

Keep in mind- At this time the following are NOT Eligible: Reverse mortgages, Mobile or Manufactured homes



* - Required field.

*First name
Middle name
*Last name
Mailing Address 1
Mailing Address 2
Mailing City
Mailing State
Mailing Zip code
Physical Address 1
Physical Address 2
Physical City
Physical State
Physical Zip code
Home phone
Work phone
Work phone ext.
Cell phone
E-mail address
County
Ethnicity
Gender
Date of birth

If you are not the homeowner filling out this application, enter information here.

Otherwise, enter emergency contact.

Name
Relationship
Address
City
State
Zip code
Home phone
Work phone
Work phone ext.
Cell phone

Application date
General Areas ADA
Appliances
Carpentry
Concrete
Doors
Electrical
Energy
Exterior Paint
Flooring
Furnace
Grab Bars/Handrails
Gutters
Hot Water Heater
Locks
Other
Plumbing
Roof
Ramp
Safety
Stairway/Porch
Trash Removal
Tub/Tile
Wall Repair/Paint
Windows
Yard Work

Comments:
Previous Recipient
Year:
Other Contact Name
Other Contact Relationship
Other Contact Phone
Other Contact Email
Hear About
Age
SSN
Are you employed?
Disabilities
Please indicate any special needs:
Income
AnnualIncome
Head of Household
Assistance Received SSI
SSDI
Food Stamps
VA Benefits
AFDC
Medicare
Medicaid
Home and Community Based Services
Caseworker Name
Caseworker Phone
Other Governmental Assistance
Single or Joint Checking and Savings Account Balance
IRA, 401(k), or similar Account Balance
Own Other Property (besides the home you live in)?
Receive Rent on Other Property?
Residents Living in Household (including head of household)
Name Relationship Age SSN Employed Disabled Gender Ethnicity Veteran
Residents Pay Rent?
If yes, how much?
Any Residents have Disabilities?
Please indicate any special needs:
Number of Pets
What kind?
Own your Home or have Tenancy for Life Agreement?
Years in Home
Plan to Sell Home in the Next Year?
Homeowners Insurance?
If no, please explain. If yes, include Insurance Company & policy number:
Number of Bedrooms
Number of Bathrooms
Number of Living Rooms
Number of Other Rooms
Tax or Other Liens on Home?
Description:
Neighborhood
Priority Board
Municipality for Land Tax?
Current Taxes Paid?
Recent Repairs/Modifications
How will these repairs/modifications be important to you or help you or your care giver?
Personal Caregiver
Something About Yourself...
Any Family Members Help with Repairs?
If no, why not?
In & Out Shower with Ease
Get to Bathroom Easily
On & Off Toilet with Ease
Bath Mat
Smoke/Fire/Monoxide Detectors
Veteran?
Single/Widowed?
Home Type