Weatherization Application
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Weatherization Application
COVER’s mission is to foster hope and build community in the Upper Valley. We do this by bringing together volunteers and homeowners in fellowship and collaboration to complete urgently needed home repair projects and by facilitating the effective reuse of household goods and building materials through our COVER Store.
COVER acknowledges it is easy to focus on the differences that separate us; we look to bridge those differences and share in our common human experience. COVER welcomes the unique contributions each person can bring in terms of their education, opinions, culture, ethnicity, race, gender identity and expression, nation of origin, age, languages spoken, veteran’s status, religion, disability, sexual orientation, recovery status, criminal histories and beliefs.
This is an application for a site visit by a COVER representative. This visit will be made as soon as time permits. All applications are prioritized by need, availability of labor, funds and materials. Participation on the jobsite by household members is welcomed and encouraged.
Date
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(mm/dd/yyyy)
COVER’s weatherization program focuses on air sealing inside your home. Please check the boxes that you think could be problem areas.
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Windows
Doors
Ductwork (mobile homes)
Bulkhead
Basement
attic access
Client Contact Information
Name
*
First Name
Last Name
What is the best way to contact you?
Phone
Text
Email
Phone Number
*
xxx-xxx-xxxx
Cell for texting
xxx-xxx-xxxx
Email
Verify Email
Street Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Mailing Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Check One
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Homeowner
Renter
To be eligible to host a COVER project there are five criteria that need to be met.
1. Homeowner Involvement
COVER is more than a repair organization. Our goal is to work with you to repair your home. The more homeowners are part of the work day the more successful the project. Homeowner involvement can look different from project to project. For example: homeowners, family, and friends can be part of the work crew if able. If not able, they can spend time and visit with volunteers and staff. Homeowners may also prepare and share lunch with volunteers and staff. Homeowners are invited and encouraged to take part in the opening introductions and the close of day reflection.
How would you like to be involved in the project?
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COVER raises all funds locally to repair homes in the greater Upper Valley. We do not receive state or federal funding. On average, project costs for are between $100.00 and $2500.00.
If accepted what amount could you contribute toward the project cost? Average contributions are between $300 and $1000.
Your application will not be effected by your ability to contribute
2. Urgency
Home repair projects need to be urgent , not regular maintenance or emergencies. A few examples of urgent home repairs would be: your roof is leaking, you are losing a lot of heat because your skirting is in disrepair, you are unable to safely get in and out of your home, you have holes in your floor. (Our scope is work is not limited to these examples.)
3. Service Area
You need to be in our service area. We are a small organization, our service area is limited to within 45 minutes of White River Junction, where our office is located. We use Google Maps to determine travel time from WRJ to your home address.
4. Volunteer Friendly
Work Projects need to be volunteer friendly. Our work crews are made up of a work crew leader (staff), an assistant work crew leader(staff) and volunteers. Work projects cannot require licensure (plumbing and electrical). Work projects cannot be dangerous. For example, we only work on single story, low pitched roofs. Work projects cannot need large equipment.
5. Homeowners need to income qualify
Household income must be equal to or lower than 60% of the region’s Area Median Income (AMI). For example, monthly income before taxes for 1 person cannot exceed $2990, 2 persons-$3415, 3 persons-$3840, 4 persons-$4,265, 5 persons-$4,610, 6 persons-$4950, 7 persons-$5,290, 8 persons-$5,630
Occupants of Household-- list name, estimated gross monthly income separated by commas. (Include all sources of income)
Occupant #1
*
One occupant per line.
Age
*
Occupant #2
One occupant per line.
Age
Occupant #3
One occupant per line.
Age
Occupant #4
One occupant per line.
Age
Occupant #5+
Add all additional occupants, ages, income here
Age
Total monthly income from all sources
*
# of Veterans in Household
How many veterans, if any, live in this household
When was your furnace last cleaned?
Site Information
Description of your air sealing needs. (Please note if you need skirting, you need to use the Home Repair Application)
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Directions to the site (if GPS is not accurate)
Color of your home or distinctive features:
House Type
*
Mobile Home
Wood Home
Furnace Fuel Type
*
Oil
Pellet
Wood
Kerosene
Electric
Propane
Monthly Expenses
Choose one
*
Mortgage
Lot Rent
Own Home
Please describe any unusual expenses you have.
Additional helpful information
Alternate contact (if any) who may discuss this applcation for you
Name, relationship, email, phone
Referring Agency contact (if any)
Name, agency, email, phone
How did you hear about COVER?
*
Would you like to receive our newsletter or COVER updates?
Yes
Not at this time
Additional comments
Thank you
A COVER representative will contact you for a phone intake to assess the project.