HOMEOWNER APPLICATION

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About Us: is an all-volunteer registered non-profit organization that provides entirely free home repair services for low-income homeowners and non-profit facilities. We are part of the Rebuilding Together national affiliate network. Our work is made possible by volunteers and charitable donations. Our Programs: We accept applications year-round, but we only do one day of rebuilding on the National Rebuilding Day the last Saturday in April. We are able to consider most minor to moderate repair requests, however, Rebuilding Together Spokane does not offer emergency repair services, roof replacements, foundation stabilization, and certain major plumbing (such as a new side sewer system) or major electrical (such as panel upgrades or whole house rewiring) work. Basic Criteria: To be considered for our programs, homeowners must meet the following criteria: You must live in our coverage area that spans the greater Spokane area You must be the legal property owner You must currently live in the home and plan to remain living in the home for at least the next 3 years You must be low-income and reasonably unable to complete the work on your own If you are a senior citizen (65+), person with a disability, and/or a family with children under 18, income limits for a household of the following sizes are: 1 person 2 people 3 people 4 people 5 people 6 people $21,950 $25,050 $28,200 $31,300 $33,850 $36,350 Common Repairs: Wheelchair ramps and other accessibility improvements Installation of grab bars to improve safety Light plumbing and electrical work Flooring repair or replacement Painting, interior and exterior Limited or partial window repair or replacement Clutter removal Yard clean-up Minor general repairs Excluded Repairs: Major roof work, including replacements Major plumbing or sewer line repair Major electrical work, including rewiring Foundation repairs and major structural repairs Cosmetic repairs or non-mission-focused improvements Emergency repairs 1

How to Apply: Complete and submit the application, along with copies of the following documents: Income Verification Acceptable verification includes your most recent tax return and benefits or other income statements (Ex. Social Security, disability, unemployment, pension, etc.) Insurance Verification Cover page listing coverage amounts of homeowner s insurance policy Please mail your completed application and materials to: : We know that asking for help can be difficult, so it is our goal to make the application process as easy as possible. Here is a step by step guide to what you can expect as a homeowner applying for help through. 1. Download and print an application. If you would like an application mailed to you or need assistance filling it out, please contact our office at 509-789-3714. Leave a message and someone will return your call. 2. Fill out the application completely, including all pages and providing all supporting documents. a. Your most recent tax return and/or benefit statements or other income verification. b. A copy of your homeowner's insurance policy cover page. 3. Initial and sign the last page of the application and mail it to the P.O. Box listed above. 4. Once we receive your application, our staff will contact you in 1-2 weeks to set up a time to preview the repairs you are requesting. 5. After the initial site preview is completed, you will receive a letter notifying you whether you have been approved for our program. 6. If you are approved, we will begin finding the volunteer group(s) and funding to complete your project. a. This process can take some time depending on the number and type of repairs that are requesting. If you have questions about the application process or aren't sure of your application status, please call our office at 509-789-3714. Leave a voicemail and someone will return your call. 2

THE PROCESS AND TIMELINE Submission and Processing House Preview and Application Review Waitlist and Volunteer Matching Project Planning and Completion Application Submission and Processing - We process your application to ensure you meet our basic criteria for service. - We will contact you if we have any questions or require additional documentation. - Please note, incomplete applications, including missing supporting documentation, will delay our processing timeline. House Preview and Application Review - Once we receive a fully completed application, our staff will call to arrange a house preview. - During our meeting we will answer any questions, conduct a walk through of your home, and look at the repair work you have requested. - We will then review your application to determine if we anticipate being able to serve you through our programs within the next year. Waitlist and Volunteer Matching - You will receive a letter in the mail notifying you of our decision. -If we approve your home for our programs waitlist, we will then look for a volunteer and/or sponsor group to complete some, or all, of the requested repairs. - When we find a volunteer match we will call to discuss Project Planning and Completion. 3

First Name Address Primary Phone Alternate Contact Name Relationship To Applicant Homeowner Contact Information Last Name City, Zip Code Email Alternate Contact Phone Number How did you hear about us? Homeowner Background and History Ethnicity (optional) Date Of Birth Age Has anyone in the home served in the military? Is anyone the spouse of a living or deceased veteran? Is anyone in the home currently disabled? Please describe any disabilities and/or limitations Does anyone in the home have a caseworker? Has anyone in the home been convicted of a crime? (Checking Yes will not negatively impact your application) Date of Service Branch Dates of Service Branch Do you intend to live in your home the next 3 years? Have you ever applied to Rebuilding Together Spokane? Has our organization ever done work on your home? Who in the household? Caseworker name and phone If Yes, please explain how the conviction has impacted your ability to maintain a steady income? If not, please explain. When? When? 4

Household Members Please list everyone who lives in the house, including children, temporary residents, and renters. Full Name Relationship Age Please attach additional sheets, as needed, in order to include all individuals who reside or stay in the home. Household Income Information We require a copy of all income statements: tax returns, benefits statements, rental income, etc. Full Name Monthly Wages/Salary Monthly Benefits* Other Monthly Income** $ $ $ $ $ $ $ $ $ $ $ $ Annual Income *Benefits include pensions, Social Security, SSI/other disability benefits, unemployment, etc. **Please include any rental income within the last 12 months and any other sources of income. Are there any special circumstances regarding income or expenses within your household? (ex: temporary or seasonal unemployment, healthcare expenses, etc. that we should be aware of?) Please explain below. Please attach additional sheet, as needed, in order to include all income earners. 5

Property Information We require a copy of your current homeowner s insurance policy face/cover sheet. Do you have current homeowner s insurance? Year Built Do you have a mortgage? Year Purchased If so, are you behind in any payments? What is your Monthly Mortgage Payment? Purchase Price $ Do you receive any utility assistance/reductions? Repairs and Assistance Needed We are not able to replace roofs, re-pipe or do major sewer repairs, fix foundations, or rewire houses. Area to be addressed: Brief description of the work needed Gutters/Soffits Exterior Siding Porch/Steps/Ramp/Grab Bars/Handrails/Other Accessibility Issues Windows/Doors Walls/Ceilings Flooring Electrical Plumbing Clutter Removal/Cleaning/Yard Work Painting (Interior and/or Exterior) Weatherization Other Repair Needs 6

Homeowner Disclosure Agreement Directions: Please initial (on the lines provided) all statements that you agree with. Your signature is required to complete your application. Please call our office at 509-789-3714 if you have any questions. Leave a message and someone will return your call. My signature below indicates that all the above information provided are accurate and complete. I have read the application instructions and understand the application process I understand that (RTS) is a free service to homeowners in need and I certify that I do not have the financial means to pay for the repairs for which I am applying. I understand that if RTS accepts my application it does not guarantee that all the requested work will be done because the services are subject to available funding and volunteers. I understand that I may be asked to provide additional documentation. I authorize RTS to verify any information, including conducting a personal or criminal background check, for any applicant or other adult living in the home. I understand that RTS retains the right to decline my application or end their services in the event that any illegal activities at my residence are detected or suspected. I certify that any alcohol, drugs, and firearms or weapons are securely put away and will remain so during any visits or work performed by RTS representatives and/or volunteers. I give permission for trusted RTS representatives to inspect my home for purposes of selection and/or repair, and look at all rooms/spaces in my home. I also give permission to trusted RTS volunteers to complete the work at my home, if my home is selected. I give permission for trusted RTS representatives to take and use photos of me, my family, my home and repair needs. Applicant s Signature Date If this form has been prepared by someone other than the homeowner, please complete the following: Name of Preparer: Relationship to homeowner: Agency/Employer: Phone number: 7