Begin a critical home-repair application | Highland Rim Habitat for Humanity

Digital application

Tell us what your home needs.

Review the guided form below. Its secure delivery status is checked before submission; if online delivery is unavailable, use the printable application or call HRHFH for help.

Checking secure submission status. You can review the form now. If online delivery is unavailable, the form will provide a printable application and phone option.

Eligibility and household

Review before starting

Critical home-repair eligibility

The source application says these requirements will be verified. Check each item only if it describes your household and home.

I have owned the home for at least 12 months. * The home is in Coffee or Franklin County, Tennessee, is owner-occupied, and has been the primary residence of all owners for at least 12 months. * The home needs essential occupancy repairs; cosmetic repairs alone are not the reason for applying. * Property taxes are current. * Mortgage payments are current, if there is a mortgage. * Current homeowner's insurance is in effect. * I am willing to attend homeowner education classes. * I am a U.S. resident or can provide documentation of legal residency. *

County *Household annual income *Coffee: $18,451–$49,204; Franklin: $19,048–$50,795 in the source packet.Expected sweat-equity hours *The source packet lists 20–50 hours based on family size.

Applicant

Applicant name *Alternative or former namesSocial Security numberThis information is included in the completed PDF emailed to designated HRHFH staff.Email address *Home phoneCell phoneWork phoneAgeDate of birth

Marital status

MarriedSeparatedUnmarried

Co-applicant

Co-applicant nameAlternative or former namesSocial Security numberThis information is included in the completed PDF emailed to designated HRHFH staff.Email addressHome phoneCell phoneWork phoneAgeDate of birth

Marital status

MarriedSeparatedUnmarried

Applicant household

List dependents and anyone else who will live with you. Add details for up to six household members here; use the comments box later if you need more space.

Name	Age	Gender, if provided

Co-applicant household

List dependents and anyone else who will live with you. Add details for up to six household members here; use the comments box later if you need more space.

Name	Age	Gender, if provided

Applicant address

Present address

Present housing

OwnRentRent-free

Years at present address

Previous address, if present address is less than two yearsYears at previous address

Co-applicant address

Present address

Present housing

OwnRentRent-free

Years at present address

Previous address, if present address is less than two yearsYears at previous address

Housing, employment, and income

Willingness to partner

Partnership may include sweat equity, classes, and other approved activities. Homeownership applications generally require approximately 350–450 hours; repair applications generally require 20–50 hours based on household size.

Applicant *

YesNo

Co-applicant

YesNo

Home repair property information

Monthly mortgage payment, including taxes and insuranceUnpaid mortgage balance

Own land other than residence?

NoYes

Monthly payment on other land

Applicant employment

Current employer name and addressCurrent employer start dateAnnual gross wagesType of businessBusiness phonePrevious employer name and address, if current job is less than one yearYears at previous jobPrevious annual gross wagesPrevious business typePrevious business phone

Business owner or self-employed

Ownership share, if self-employed

Less than 25%25% or more

Monthly self-employment income or loss

Self-employed applicants may be asked for tax returns and financial statements during review.

Co-applicant employment

Business owner or self-employed

Ownership share, if self-employed

Less than 25%25% or more

Monthly self-employment income or loss

Self-employed applicants may be asked for tax returns and financial statements during review.

Monthly income

Enter monthly amounts for each income source. Alimony, child support, and separate maintenance information may be required for this Special Purpose Credit Program when applicable.

Income source	Applicant	Co-applicant	Other household	Total
Salary/wages (gross)
TANF
Alimony
Child support
Social Security
SSI
Disability
Housing voucher (e.g., Section 8)
Unemployment benefits
VA compensation
Retirement (e.g., pension)
Military entitlements
Other 1

Household members whose income is listed above

Name	Income source	Monthly income	Date of birth

Start the critical home-repair application.

Critical repairs protect the home you already own.

Tell us what your home needs.

Critical home-repair eligibility

Applicant

Co-applicant

Applicant household

Co-applicant household

Applicant address

Co-applicant address

Applicant military service

Co-applicant military service

Willingness to partner

Present housing conditions

Home repair property information

Applicant employment

Co-applicant employment

Monthly income

Household members whose income is listed above

Declarations

Demographic information

Applicant

Co-applicant

Authorization, agreement, and release