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Critical Home Repair Pre-Application

Critical Home Repair Pre-Application

This form gives Helena Area Habitat the information needed to determine your needs, and if you qualify for a home repair.
This is NOT an emergency or crisis-based resource. There can be no guarantees of eligibility made at this stage.

Click here to download the pre-application or fill out the form below.

Homeowner Information:

List ALL sources of monthly household income, including the income from all household members, regardless of age.

Sources include, Employment, SSI, SSDI/Disability, Child Support, Kinship Care, Retirement, Workers Compensation, Unemployment, Etc.

List ALL monthly debt payments, including but not limited to utility payments, auto loans, personal loans, credit card bills, medical bills, student loans, childcare, taxes, insurance, etc.

Information about your home:

By my signature, I affirm that the information on this form is true and correct. I understand that providing false information could cause me to be disqualified from Helena habitat’s program. I understand that in no way am I being offered counseling services by submitting this form. IF YOU DO NOT SIGN THIS FORM, IT WILL RESULT IN IMMEDIATE DENIAL AS THE DOCUMENT WILL BE INVALID.