Rock the Block Application | Habitat for Humanity of Oakland County

Please complete the form below if you are interested in participating in our Rock the Block program and having exterior repairs completed on your home. Some services are still available for renters.

Applications are currently being accepted for the August 6^th and 8^th Rock the Block event in the Ferry Farms/Unity Park Neighborhood 2020, Pontiac. Projects must be located within the identified area located here.

Ferry Farms/Unity Park Neighborhood 2020

Thursday, August 6th, 2020 - Saturday, August 8th, 2020

Contact Information

Name

First*

Last*

Address

Street Number*

Street Name*

City*

State*

Zip Code*

Phone*

Email*

Date of Birth*

T-Shirt Size

Armed Forces Service*

Household Information

How Long Have You Lived in Your Home?*

How many adults, 18 years or older, live in your household?*

adults

How many children, 17 years or younger, live in your household?*

children

Household Disability Status (optional)

One or more household members has a disability

N/A

Do you have accessibility needs, interior or exterior, that are not being met? (installation of grab bars, widened doorways, wheelchair ramp, etc.)

Yes

Are you currently a recipient of CHORE services offered through the City of Pontiac & OLSHA?

Yes

Are you a DTE Customer?

Yes

How did you hear about Habitat Oakland?*

Referring Homeowner Name

Program Eligibility

Please answer the questions below to provide Habitat with information about your current housing status, ability to pay for repair services and your willingness to partner with our organization.

Homeownership* (Check All that Apply)

I am the legal owner of my home (my name is listed on the property deed)

I am NOT the homeowner; I am currently renting the home

This home is my primary residence

I am current on my property taxes or current on a payment plan for delinquent taxes

I am current with my homeowner's insurance policy

Ability to Pay* (Check All that Apply)

I understand that Habitat will charge a reasonable fee for the services I am approved for

My fee will be reviewed with me and agreed upon prior to project approval

My fee is due and shall be paid in full prior to the work day on my home

If my project is approved, I will be charged an additional program administrative fee of $10

Willingness to Partner* (Check All that Apply)

I will be available and participate in work done at my home alongside Habitat volunteers when scheduled

I will put in the required number of sweat equity hours for my project (4-8 hours)

I am willing to display partnership materials (lawn sign, stencil)

Rock the Block - Home Repair Service Available

This program focuses on simple exterior home repairs that will be completed by our team of volunteers. Included in this program is a FREE energy audit from the Consumers Energy Helping Neighbors Program for qualified households. A technician will come to your home to perform energy tests to help identify ways to reduce your energy costs. Some people are eligible for free energy upgrades. For more information about this FREE service, click here. You will automatically be referred to this program.

Below is a list of services available. Price ranges are based on typical services and are subject to change based on an assessment.

Financial Information

Please select the sources of income for your household. Ex: Job, Social Security, Child Support, etc. Please list the amounts BEFORE taxes.

Income Source

How Often Are You Paid?

Amount Per Check

Income Source

How Often Are You Paid?

Amount Per Check

Income Source

How Often Are You Paid?

Amount Per Check

Income Source

How Often Are You Paid?

Amount Per Check

Authorization & Release* I understand that by submitting this application form, I am authorizing Habitat for Humanity of Oakland County (HFHOC) to evaluate my eligibility for home preservation services which includes a criminal background, sexual offender check, verification of homeownership and property tax status. I have answered all the questions on this form truthfully. The original or a copy of this form will be retained by HFHOC even if the application is not approved. HFHOC will only share the information on this application form with outside agencies offering services that I may be eligible for (such as OLHSA, Faith in Action and DTE Energy) and as needed to provide preservation services I select and are part of the program such as Consumers Energy.

I Agree

I understand that:

Only projects that can be completed in 2 days will be approved.

The requested services and completion of my project is dependent on the number of volunteers that register for the event as well as weather conditions.

Services must meet volunteer safety requirements and those that do not will not be completed.

Please Fill Out Your Name as a Signature*

Information for Government Monitoring Purposes

The following information is requested by the federal government for housing programs in order to monitor the organizations compliance with fair housing law. You are not required to furnish this information, but are encouraged to do so. The law provides that an organization may neither discriminate on the basis of this information, nor on whether you choose to furnish it or not. However, if you choose not to furnish it, under federal regulations this organization is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the information below, please check the box below.

I do NOT wish to furnish this information

What race do you identify with?

Do you consider yourself Hispanic, Latino, Latina, or of Spanish Origin?

What gender do you identify with?

I have read Habitat for Humanity of Oakland County's Privacy Policy

I agree