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Thank you for your interest in services from Rebuilding Together of the Triangle, Inc. We are a non-profit organization that sponsors volunteer projects to rehabilitate the homes of low-income homeowners in Chatham, Durham, Orange and Wake counties in North Carolina.

We coordinate these services when the disrepair of the homes imposes discomfort or a safety or health hazard on its occupants, and the homeowners are unable to make the repairs themselves. We provide these services at no charge to the homeowner.

To be considered for the program, eligible applicants must own and live in their own home in Chatham, Durham, Orange or Wake County, and the household income must fall at or below 65% of Median Income. We do NOT do emergency repairs. 

To be considered for the program, please complete the application below. We will followup with you by phone for additional information.  Based on that information, we will determine whether your needs are within the scope of our mission.

Thank you for your interest in our services.

Rebuilding Together has not authorized any other person or entity to provide any services or to receive information on behalf of Rebuilding Together for purposes of this application.

Please leave blank any fields requesting your social security number.  We are working to have these fields removed from our application. Leaving these blank will not affect the submission process or consideration of your application.

 



* - 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
Source

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
Previous Recipient
Year:
Best Time To Call
Other Contact Name
Other Contact Relationship
Other Contact Phone
Other Contact Email
Hear About
Age
Are you employed?
Disabilities
Please indicate any special needs:
Household Monthly Gross Income
Income
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
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
Any Residents have Disabilities?
Please indicate any special needs:
Own your Home or have Tenancy for Life Agreement?
Years in Home
Plan to Sell Home in the Next Year?
Tax or Other Liens on Home?
Description:
Recent Repairs/Modifications
Any Family Members Help with Repairs?
If no, why not?
Veteran?
Home Type