Cover Home Repair · Home Repair and Weatherization Application (2023)

Homeowner Contact Information

Name *

First Name

Last Name

Home Phone Number *

xxx-xxx-xxxx

Cell Number

xxx-xxx-xxxx

Email

Verify Email

Alternate Contact Information

If you would like us to discuss your application with anyone else (e.g., a family member, case manager, neighbor), please add their contact information here.

Alternate contact

Please add the name, phone number, email address, and agency name if applicable.

Your Home

In order to recruit volunteers for your repair project, your address will be visible on our volunteer recruitment calendar between the time we start recruiting volunteers for your project and when your project ends. Your name will not be posted in the volunteer calendar.

Physical Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Is your mailing address different from your physical address?

Yes

Mailing Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Check One *

Homeowner

Renter

House Type *

Mobile Home

Wood Home

Mobile Home Slab *

My mobile home has a concrete slab or basement foundation

My mobile home does not have a concrete slab or basement foundation

Color of House or Other Distinctive Features

Directions to the site if GPS not accurate (include landmarks)

Application Criteria

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 with the project? *

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 $3,500 and $6,000.

If accepted what amount could you contribute toward the project cost? Contributions are between $0 and $300. *

Your application will not be affected by your ability to contribute.

2. Home repair projects need to be urgent.

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, or you have holes in your floor. COVER considers weatherization work like air-sealing and insulating as urgent. (Our scope of work is not limited to these examples). We do not do regular maintenance like painting. We cannot address emergencies; an emergency is something that needs to be addressed immediately. We cannot do projects that require licensure, for example, plumbing and electrical.

3. 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. Home repair projects need to be volunteer friendly

COVER is a volunteer-based organization. Our work crews consist of a work crew leader (trained staff), an assistant work crew leader (trained staff), and volunteers. Work projects cannot be dangerous. For example, we only work on single story, low pitched roofs. Work projects cannot need large equipment.

Brief Description of Home Repair, accessibility needs requested *

Please note if roof is currently leaking. COVER attends to home repairs in April through November and weatherization work in December through February.

5. Homeowners need to income qualify

The table below shows our monthly income limits before taxes. Household income must be equal to or lower than the amount listed.

Income Limits

Household Size	Monthly Income Limit (before taxes)
1	$3,500
2	$4,000
3	$4,500
4	$5,000
5	$5,400
6	$5,800
7	$6,200
8	$6,600

How many people live in your household? *

Occupant 1's Information:

Note: It is optional for you to indicate what groups, like veteran status or race, you identify with. We sometimes use this information to help us secure grants and foundation support for the work we do, but it is not necessary for you to fill out.

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Occupant 2's Information:

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Occupant 3's Information:

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Occupant 4's Information:

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Occupant 5's Information:

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Occupant 6's Information:

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Occupant 7's Information:

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Occupant 8's Information:

Monthly income *

Year of birth *

Identifies as:

a veteran

having a disability

LGTBQ+

Other identities, including race & ethnicity

Other Expenses and Comments

Please describe any unusual expenses you or other household members may have.

Additional Comments

Email Newsletter *

Would you like to subscribe to our once-a-month e-newsletter? We tend to include updates about our store, home repair program, and general COVER news.

Yes

No

Thank you

A COVER representative will contact you for a phone intake to assess the project.

COVER Home Repair and Store

COVER is a local non-profit that brings Homeowners and Volunteers together to complete urgently needed home repairs. Our mission is to foster hope and build community.

Homeowner Contact Information

Alternate Contact Information

Your Home

Application Criteria

1. Homeowner Involvement

2. Home repair projects need to be urgent.

3. You need to be in our service area.

4. Home repair projects need to be volunteer friendly

5. Homeowners need to income qualify

Thank you