Untitled document

 

By completing this application, applicants acknowledge:

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

I understand that a member in the home must qualify as being a senior citizen, disabled, and/or a veteran to recieve service from RTMD. The homeowner must also have resided in the home for at least 5 years. 

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

I understand that RTMD has three different programs: 

  • Painting and Landscaping
  • Critical Home Repairs (ex: drywall repairs, bathroom modifications, roof repairs, safety renovations, etc.)
  • Veteran Program (If you are a veteran, live with a veteran, or are a widow(er) of a veteran, please choose this program option in the application.)

I understand that RTMD 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 RTMD 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, for all persons living in the home
  • Identification of all persons residing in the home (Social Security Card and a Photo ID)
  • Current mortgage
  • DD214 form if you are applying to the veteran program
  • Copy of the most recent electric or utility bill
  • Copy of the most recent water bill 

I understand that I will need to provide the above documentation to RTMD 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 RTMD 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 of inspections.

I understand that if my home is not selected as a project for RTMD 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: Mobile or Manufactured homes, Town Homes, Gated Communities, Condos, Rental Properties

 



* - 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:
Year House Built
Program Applying For
Best Time To Call
Other Contact Name
Other Contact Relationship
Other Contact Phone
Other Contact Email
Hear About
Age
Disabilities
Please indicate any special needs:
Household Monthly Gross Income
Income
Monthly Mortgage Payment
Head of Household
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:
Own your Home or have Tenancy for Life Agreement?
Years in Home
Number of Bedrooms
Number of Bathrooms
Neighborhood
Current Taxes Paid?
Recent Repairs/Modifications
Something About Yourself...
Veteran?
Single/Widowed?
Home Type