Habitat for Humanity of the Greater Harrisburg Area | Critical Home Repair Application

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Questionnaire

Homeowner Name (if different than above)

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Please choose your location

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What type of dwelling do you live in?

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Best Time to contact

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Does a U.S. veteran live in the home?

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Homeowner Date of Birth

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Describe the problem you would like to have repaired:

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Total number of persons in the household

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Number of children (under age 18)

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Number of adults

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Number of working adults in the household

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Names of adult members of the household

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Income sources for adults in the household

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Is the homeowner 62 years of age or older?

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Names and ages of children in the household

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Estimated Household Annual Income (You will need to provide documentation at a later date)

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What would it mean to you and your family to have these critical home repairs completed?

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Does anyone in the household have a disability? If YES, please describe.

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Race of Head of Household: (select all that apply)

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Ethnicity of Head of Household:

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Any additional information that you would like Habitat to know regarding this application

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You are required to submit ALL of the documents listed below, via e-mail or US Mail. Please select all documents you have submitted. NOTE: Application will NOT be processed unless ALL documents are received.

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	Habitat for Humanity of the Greater Harrisburg Area Critical Home Repair Application

Thank you for your interest in the Harrisburg Habitat Critical Home Repair Program. Below, you’ll find a brief program description along with an application.

At this time, we are currently accepting applications for Critical Home Repair. Please note that we are unable to handle emergency repairs. Due to grant funding requirements and high demand for our services, there may be an extended wait time.

To be added to the waiting list as soon as possible, we require a completed application along with the following supporting documents:

Proof of Income (for each household member over 18) – Please send copies:

Federal Tax Return (most recent year). If Social Security is your sole income, provide your current Social Security benefits statement and the last three months of bank statements.
Income Verification – Past six (6) weeks of documentation for all sources of income (e.g., wages, pension, Social Security, disability, unemployment, child support, etc.).

Proof of Homeownership – Please send copies of the following:

Property Deed
Most recent mortgage payment invoice/receipt
Homeowner’s insurance declaration page (most recent proof of insurance)

For U.S. Veterans (if applicable):

Certificate of Veteran Status

Important Note: Federal regulations require us to collect ethnic/racial data for statistical reporting purposes. This information will remain confidential.

How to Submit Documents:

You can submit the required documents via email or mail. Please note that we will not follow up until all required documents are received.

📧 Email: acardillo@harrisburghabitat.org
📬 Mailing Address: 2416 Park Drive, Harrisburg, PA 17110

If you need a physical copy of the application mailed to you, please call our office at 717-545-7299 to request one.

Thank you again for your interest in our program. If you have any questions, please don’t hesitate to reach out!