Home Repair Eligibility Questionnaire

This is not a loan application.

Contact Information

About Your Home

About Repair/Work Needed

Eligibility Questions

Attach Files

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Uploaded Files


    I understand that by submitting this request for information I am authorizing Habitat for Humanity to evaluate my need for a Habitat home repair, my ability to pay for the repair, and my eligibility for the Habitat Home Repair Program. I understand that this request for information is a preliminary step, and is not a formal application. If I decide to proceed into the program, I am still expected to fill out an application. I understand when submitting an application that a credit report and criminal background check will be completed on all adults in the household. I understand that upon review of the application, credit report and criminal background check that I may not be accepted into the program. I have answered all above questions truthfully. Furthermore, it is understood that completion of this form does not guarantee that I/we will receive services through Habitat for Humanity of Dane County.

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