Apply for Assistance

The Home Builders Foundation builds independence for individuals and families most in need by creating home modifications to enable greater access, safety and mobility. Each project must meet our requisite criteria, and all projects are considered based on funds and resources available when applications are received.

The COVID-19 pandemic of 2020 altered the way we serve our clients. As we navigate this challenging time, the safety of our clients, volunteers and staff remains the most important priority for all of us. Although some processes may have changed, applications are open, and staff continues working, so please reach out with any questions. Stay well!

Home Builders Foundation Application for Assistance

Please take your time with this form as it will be key in our ability to help you. 
Primary Contact for the Application
Contact Address (If different from Applicant)
Applicant Name (Who Are the Modifications For)
Applicant Home Address ( Project Location)
Landlord Contact Information
Home Owner's Association Contact
Household Financial Information
IMPORTANT: All financial information must be provided and complete. Thank you.

Brief Description of Circumstances

IMPORTANT: Please fill our this section thoroughly. This portion of the application is weighed in the decision to move forward in the approval process. Application that do not satisfy this requirement may be denied.

Please summarize the health, disability, or situational circumstances causing the applicant’s physical disability and need for accessibility assistance from the HBF inclusive of how long you have been in need.

List any organizations that have denied other assistance
Description of Assistance Needed
Please list all of the assistive equipment that the applicant has already tried to address their accessibility challenges. Be as specific as possible and also include the outcome

Based on the description of circumstances listed above, describe the accessibility modifications you are seeking for your home

List any and all other assistance (i.e. Medicaid, VA, other nonprofits, foundations, grants, etc.) the recipient/ household is receiving. Who and what is their involvement? Be specific.

Anticipated Impact
The Home Builders Foundation’s mission is to provide opportunities for individuals and families with disabilities to achieve a better quality of life and positively enrich their communities.

Please let us know how the home modifications you listed above will impact your independence and quality of life. What do you envision or hope to be able to do, that you are not able to do today, if these modifications are completed.

IMPORTANT: Please be as specific as possible. This portion of the application is weighed in the decision to move forward in the approval process.

Attachments
Please include any attachments that you believe help describe your circumstances or needs.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx odt ppt pptx odp xls xlsx ods.
Terms of Acceptance and Signature
I, the applicant for this HBF application, warrant the truthfulness of the information provided in this application.

Electronic Signature:
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
Yes
I have read the application and acknowledge that all statements given by me in this application are complete, accurate, and truthful to the best of my ability. Due to the nature of the application, I understand the Home Builders Foundation (HBF) may share basic demographic, disability, and contact information provided on the application with the HBF staff, board and committee members, volunteer crews, and any individual(s) associated with the HBF and/or a HBF project.

I understand that the HBF may perform a title search on homes considered for home modifications. I also understand that the HBF reserves the right to deny any request based on funds and resources available to the HBF, location of project, and applicability to the HBF mission.

Yes
As part of the application, approval and project process, I understand that I may be photographed or recorded. I authorize the HBF to photograph, take motion pictures, take video footage, and/or electronic sound recordings of myself and/or any extension of me (i.e. home, present family members, etc.) for the purpose of reproduction use necessary to help promote, educate, and build awareness to support the HBF mission.
Yes
Further, I agree to sign and return a Work Agreement for the scope of work to be completed at my home. I understand that if that document is not filled out in the timeframe requested by the HBF, it may delay the start of the project. If needed, I also agree to pull a permit for the work with my local jurisdiction. I agree to complete and return a Project Completion Form within two weeks of project completion. I understand that if that document is not filled out and returned, that signing this application will meet the same requirements, terms and conditions as the Project Completion Form. Finally, I acknowledge that the HBF reserves the right to terminate the contract and discontinue project work at any point during the application process and/or during the performance of the scope of work in circumstances where the HBF determines the safety and/or wellbeing of its volunteer contractors, staff and/or organization as a whole may be in jeopardy. A written notice of termination will be given by the HBF five (5) days prior to termination.
Yes
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The Home Builders Foundation is a 501(c)(3) non-profit organization. Tax EIN 84-1263718