Home Repair Application

To qualify for home repair assistance from the Hinton Rural Life Center…

· The person should own (not rent) the home / property.

· It has to be a safe working environment for our groups.

· There must be financial need (or extenuating circumstances).

· Deadline for consideration: April 15, 2018

All applications are considered. Please note the following:

· Our construction coordinator selects appropriate worksites based upon specific criteria, and the skills and preferences of the registered volunteer groups.

· The Hinton Center does a variety of repairs, but no roofing.

· Our volunteer groups are not professionals.

· The Hinton Center generally makes repairs in an area of a one-hour drive time radius of Hayesville, North Carolina, within Clay and Cherokee counties (NC) and Towns (GA).

I agree to and understand the following when applying for and receiving help from the Hinton Center:

1. I understand that submitting an application does not guarantee that my home will be repaired.

2. I understand that everything requested on my application may not be done to my home.

3. I agree to have someone present at my home while the work is being done, unless prior arrangements have been made with Hinton Center staff.

4. I understand that sometimes a Hinton Center group may start a project but because of uncontrollable circumstances may not be able to finish. I also understand that Hinton Center will try to have agreed upon work finished if at all possible.

5. I understand and agree that restroom facilities will be made available by me in my home for the work group members while they’re on-site, unless other arrangements have been made with Hinton Center staff.

6. I understand that any used project materials are the property of the Hinton Center and will not be left at my house, except for some paints and stains.

7. I understand that pictures may be taken at my home by the Hinton Center / work teams and may be used to promote the mission of Hinton Center.

8. I understand that if contact information (including my phone number changes), I’m responsible for informing Hinton Center staff. Call Tammy at 828-389-8336 or email missions@hintoncenter.org.

Name

First NameLast Name

Date

Date of birth (mm/dd/yyyy)

Address

City

State

Mailing Address (if different from physical address)

Email

example@example.com

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Can you send and receive text messages?

YesNo

Referred by (if applicable)

Referral Agency (if applicable)

Referral Agency Phone (if applicable)

Referral Agency Email (if applicable)

Directions to home from Hayesville, N.C.

Amount/Materials available from homeowner/sponsor (not required to receive assistance from Hinton Center)

Please list work requested

Type of dwelling

Frame HouseBrick HouseMobile HomeOther

Number of individuals in home

Please list any special circumstances (if applicable)

How did you hear about Hinton Center?

Hinton Center appreciates our local volunteers. Would you like a way to give back? If so, our volunteer coordinator will contact you!

YesNo

Hinton Center applies for grant funding to help with many of our ministries. The following information is OPTIONAL for you to fill out, but your responses are appreciated.

Optional Question 1: Are you or is any member of your family (in the household) a veteran?

YesNoDecline to Answer

Optional Question 2: Are you or is any member of your family disabled?

YesNoDecline to Answer

Optional Question 3: Are you a widow?

YesNoDecline to Answer