Rebuilding Together - Fargo Moorhead

Homeowner Application

Thank You for your application to Rebuilding Together Fargo-Moorhead Area.

* Required field

Homeowner Application
Applicants must meet income guidelines: 1-2 residents adjusted gross income is no more than $26,000 annually. Add $6,000 for each additional resident in the home to come up with the total combined income. You must also be the homeowners and 1 of the following:
* Application Date
Over 65
Section 1 - Homeowner Information
* First Name
* Last Name
Home Address 1
Home Address 2
Home Phone
Work Phone
Work Phone Extension
Cell Phone
Email Address
Section 2: Personal Statement
Personal Statement
Section 3: Special Needs
Does anyone in the home live with a disability? Check all that apply
Other Disability
Disability Comments
Name of disabled resident
Section 4: Type of repairs to be considered
Handy Man Repairs
Carpentry repairs
Carpentry Other
Electrical repairs
Electrical Other
Painting or wall repairs
Plumbing Details
Plumbing Other
General cleaning and yard work
General Cleaning or Yard Work Other
HandyMan Description
Green Housing Repairs
Energy Efficiency
Energy Efficiency Other
Major Appliances
Major Appliances Other
Green House Description
Roofing Repairs
Major roofing repairs
Major Roofing Repairs Other
Minor roofing repairs
Minor roof repairs Other
Roofing Description
Safe at Home
Safe at Home Major Repairs
Safe at Home Major Other
Safe at Home Minor Repairs
Safe at Home Minor Other
Safe at Home Description
Prioritize Repairs: Please list repairs that are most inmportant to you and need immediate attention.
Priority 1
Priority 2
Priority 3
Section 5: House Information
Name Listed on Deed
Is the deed in a living or family trust?
Yes No
Number of years homeowner has lived at this address
Has the property been cited for any building or health code violations? (If yes, please attach a copy of notification)
Will your home be sold in the next
Do you have Homeowners Insurance?
Yes No
Proof of current homeowners insurance - showing Homeowners name, address and dates of coverage
Is there a mortgage on this home?
Yes No
Name of Mortgage Compay
Have you missed a mortgage payment over the last 12 months?
Yes No
If you have missed a payment, how many?
Are you a member of a homeowners association?
Yes No
HOA Name and Phone
Section 6: Application History
Have you applied to Rebuilding Together in the past?
Yes No
What years did you apply to RT?
Has Rebulding Together done work at your home in the past?
Yes No
If RT did work in the past, what year?
How did you hear about Rebuilding Together?
Section 7: Income Verification
Do you qualify for a homestead tax credit or property tax rebate?
Yes No
Please list special circumstances regarding expenses within your household such as home health care, hospital costs, medical expenses, etc...
Please list the name of any member of you household who is unemployed (Do not include individuals in grades K-12, retired individuals, or those receiving Social Security):
Are there any renters residing in your home?
Residents Pay Rent?
Section 8: Verification Documents Required
Proof of homeownership - such as the deed or property tax receipt; must show thet name and address of the applicant
Proof of current homeowners insurance - showing Homeowners name, address and dates of coverage
Proof of Income - such as most recent income tax statement for each person over the age of 18 living in the home - showing Adjusted Gross Income is all that is necessary. For your privace, please block out any social security numbers. If a resident did not file a return last year or is now working, please provide a statement for all earned income (including social security, disability or other benefits; payment stubs from employers, etc.) or proof of student status.
Green Housing repairs requests ONLY. Copies of energy bills for the home from the past 12 months.
Residents Living With You
This entry will be deleted on submit!
Last Name
First Name
Date of Birth
Relationship to Owner
Yes No
Race - Optional
Veteran - Please provide Branch and date of service