Home Repair Application

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Applicant Information

Primary Applicant*
Email*
Additional Homeowner (if applicable)
Email

Property Information

Address*
County*

Ownership Information

Include the number of people currently living inside the home, not just those listed on the deed or mortgage.
Do you own and occupy this home?*
Is this your primary residence?*

Income Eligibility

Is your total household income within the program's income guidelines?*
Including all household members living in the home.
Do you currently have a mortgage on this property?*
If yes, are you current on your mortgage payments?*
Are your property taxes current?*

Liens & Judgments

Are there any liens or judgments against you or this property?*
Definition: A lien or judgment is a legal claim against your property due to unpaid debts or a court order that, in some cases, may give the creditor the right to take possession of your property.

Repair Needs

The following questions are completely optional. You are not required to provide this information to be considered for assistance.

Habitat for Humanity of the Lehigh Valley collects demographic information to better understand the communities we serve and to share the impact of our programs with our funders, partners, and other stakeholders. This information is used for reporting purposes only and will not affect your eligibility for services.

If you are comfortable doing so, we encourage you to complete the following questions.

Household Information

Senior (Age 65+)
Person with a Disability
Veteran

Race

Choose One

Ethnicity

Choose One

Country of Origin