Mobile Home Repair Application - Habitat for Humanity of Oakland County

Please complete the form below if you are interested in receiving mobile home repair services. Eligibility rules apply.

Contact Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name of Mobile Home Park *

Phone *

Email *

Date of Birth *

Armed Forces Service *

Which Branch of Military?

Household Information

How Long Have You Lived in Your Home? *

Do you rent or own your home? *

Rent
Own

Landlord Name or Property Management Company

Landlord's or Property Management Phone Number

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

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

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
No

Are you a DTE Customer?

Yes
No

Was your refrigerator built prior to December 2013?

Yes
No

How did you hear about Habitat Oakland? *

Referring Homeowner Name

I would like to receive updates from Habitat Oakland

Yes
No

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
If my project is approved, I will be charged an additional program administrative fee of $35

Willingness to Partner (Check All that Apply) *

I will put in the required number of sweat equity hours for my project (up to 15 hours)
I am willing to display partnership materials (lawn sign, stencil)

Mobile Home Repair Service Available

This program focuses on mobile home repairs that will be completed by licensed contractors. 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. For more information about this FREE https://www.habitatoakland.org/helpingneighbors/ service, click here. You will automatically be referred to this program.

Below is a list of services available. For approved projects, the actual scope of work for repairs are subject to changes 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. Supporting financial documents will be requested upon application processing.

Income Source 1 *

Choose One

How Often Are You Paid? *

Amount Per Check *

Income Source 2

Choose One

How Often Are You Paid?

Amount Per Check

Income Source 3

Choose One

How Often Are You Paid?

Amount Per Check

Income Source 4

Choose One

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:

This program is based on a first-come, first-served basis determined by receipt of a completed application.
Supporting financial documents will be requested during processing of application.
The requested services and completion of my project is dependent upon the results of a site assessment and availability of program funding.
This is not an emergency program. For emergency repairs, applicants will be referred to programs equipped to address emergency repairs.

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?

Race/National Origin Explanation

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

What gender do you identify with?

Gender Identity Explanation

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

I agree