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Application for Home Repair Service
Applicant Information
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First Name
Last Name

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(mm/dd/yyyy)

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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Co-Applicant Information
Fill this section out if you are applying with another member of your household. If your home is jointly owned, you MUST include the co-owner as your co-applicant.

First Name
Last Name


(mm/dd/yyyy)


Sponsor Information
If you are applying on behalf of yourself, you do not need to fill out this section.


First Name
Last Name


Property Information
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This should include all persons 18 and older
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If there are no children, please put 0
Optional Disclosure
As we apply for grants and continue to serve our community, collecting the following data is useful. This is optional, and your responses will not impact your application.



Requested Repairs
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Select all that apply. Please note: due to the current COVID-19 pandemic, we are not currently conducting indoor repairs.
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Sweat Equity Agreement
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Habitat for Humanity focuses on strengthening communities through service. To be considered for Habitat for Humanity Snohomish County Home Repair Service, applicants must be willing to participate in the process. Your participation is called “sweat equity”. The level of sweat equity will be based on the scope of repair work and your ability to assist. Sweat equity comes in many forms including help with prep work, clean up, and construction, as well as providing food or beverages for the volunteer work crew. The total hours of sweat equity can be split between family and friends to suit each individual’s ability. The number of sweat equity hours will be determined before the Repair Service Agreement is signed.
Applicant Employment Information




Co-applicant Employment Information




Total annual household income
Please provide each applicant's total annual income, including gross employment income, Social Security, SSI, Disability, Temporary Assistance for Needy Families (TANF), Food Stamps (Food EBT or SNAP), Alimony, Child Support, and all other sources of income. Please note that you will be required to attach supporting documents later in this application. Please note that the form does not accept commas, and you should insert income accordingly. (i.e. put 1500 instead of 1,500)
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If none, select 0

First Name
Last Name


First Name
Last Name


First Name
Last Name


First Name
Last Name


First Name
Last Name


First Name
Last Name

Income Verification
Please attach copies of the following documentation: most recent utility bill with your name and address clearly visible on the bill (i.e., electric bill) and tax return for the most recent year. If you do not file a tax return, provide copies of your most recent Social Security statement, retirement or pension statement, W-2 form, and all 1099 forms. If co-applicants file separately, please provide this income information for each applicant.
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Authorization and Release
I understand that by filing this application, I am authorizing Habitat for Humanity to evaluate my actual need for Habitat home repairs and my willingness to partner. I am also authorizing Habitat for Humanity to evaluate my ability to repay for any material costs that are accrued during the home repair, if necessary. I understand that the evaluation will include personal visits and, possibly, a credit check and employment verification. I have answered all questions on this application truthfully to the best of my ability. I understand that if I have not answered the questions truthfully, my application may be denied. I also understand that Habitat for Humanity screens all potential staff (whether paid or unpaid), board members and applicant families on the sex offender registry and that, by completing this application, I am submitting to such an inquiry.
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(mm/dd/yyyy)


(mm/dd/yyyy)

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