Habitat Helping Hands Application

Habitat Helping Hands serves Columbia and Greene County seniors, disabled and/or low-income homeowners who have few resources available to them. Like our affordable home ownership programs, we seek to give a hand-up to folks: helping them achieve the strength, stability, and self-reliance they need to build better lives for themselves, their families, and our community.

Homeowner Contact Information

First Name *

Last Name *

Email *

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Household Demographics

Are you a US Citizen or legal permanent resident? * The field Are you a US Citizen or legal permanent resident? is required.

Ethnicity * The field Ethnicity is required.

Check if you are: * The field Check if you are: is required.

Gross annual household income (before taxes)? * The numeric field Gross annual household income (before taxes)? is required.

Are you or a member of your household receiving assistance from a county agency? If yes, which agencies? * The field Are you or a member of your household receiving assistance from a county agency? If yes, which agencies? is required.

List ALL the occupants at this residence (including homeowner): * The field List ALL the occupants at this residence (including homeowner): is required.

Number of children in house and ages * The field Number of children in house and ages is required.

Please indicate if you meet the following qualifications (Yes/No):

This project is at an “owner-occupied home” (NOT a rental property): * The field This project is at an “owner-occupied home” (NOT a rental property): is required.

This home is located in Columbia County or Greene County, NY: * The field This home is located in Columbia County or Greene County, NY: is required.

I have adequate homeowners insurance: * The field I have adequate homeowners insurance: is required.

I have financial or physical limitations that prevent me from completing the project myself: * The field I have financial or physical limitations that prevent me from completing the project myself: is required.

I am able to contribute a nominal portion of the cost of materials (depending on project): * The field I am able to contribute a nominal portion of the cost of materials (depending on project): is required.

Someone from my family, is willing to partner with Habitat volunteers in the completion of the project: * The field Someone from my family, is willing to partner with Habitat volunteers in the completion of the project: is required.

Please provide a brief description of your repair or improvement project: * The field Please provide a brief description of your repair or improvement project: is required.

Certification

I understand that providing false information disqualifies this application from consideration.

By typing my full name below, I affirm that the above information is true and accurate: * The field By typing my full name below, I affirm that the above information is true and accurate: is required.