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Willingness to Partner 

I understand that by filing this application, I am authorizing Habitat for Humanity to evaluate my actual need for assistance and my willingness to partner. I understand that the evaluation may include personal visits and photographs of the home. I have answered all the questions truthfully. I understand that if I have already been selected, I may be disqualified from the program, if my answers are found to be untruthful.

Greater Des Moines Habitat for Humanity's Rock the Block® program helps to revitalize homes and neighborhoods in Polk, Jasper and Dallas County through non emergency repairs. In order to be considered, all applicants must own a home in one of those three counties. Applicants must fall within our income requirements and be willing to pay any and all service fees. 

To be considered for Greater Des Moines Habitat for Humanity's Rock the Block® housing assistance, you and/or a family member must be willing to complete (8) hours of sweat equity, which could include an  optional course in Financial Literacy. Sweat equity can range from volunteering on sites, helping in the ReStore, or even baking cookies depending your capability. Homeowners' completing their sweat equity helps Habitat for Humanity continue it's fight on impoverished housing by keeping the work force volunteer driven. 

Applicant Contact Information

The information on his application will help us determine if you qualify for the Rock the Block® home repair program. Please complete the application and provide required documents of income verification. All information will be kept confidential. Any incomplete applications or missing documentation can delay or disqualify applicant(s).

Household Information

If the applicant has purchased their home under contract and are accepted into the Rock the Block® program,  Greater Des Moines Habitat for Humanity may need to contact and gain consent from the  contract holder in order to complete the requested work. It is the sole responsibility of the applicant to provide the name, phone number and address of the contract holder to Greater Des Moines Habitat for Humanity upon request. Failure to do so in a timely manner will hinder and potentially lead to termination of program eligibility. 

Household Member Demographics


Please enter your monthly income before taxes. For household member that are 17 years of age or younger, enter 0.00.

Areas of need

To add additional on need, click "add another response" at the bottom right of this question.

To add more than one photo, click "Add another response" and upload an additional photo.

Documentation of Income

Greater Des Moines Habitat for Humanity requires that all applicants applying for the Rock the Block® program provide proof of income in order to be considered eligible. Applicants may either provide three months of paystubs, their social security award letter or a bank statement only showing deposits. Applicants are given the choice to either mail in copies of these documents or attach a digital copy using a document uploading tool. 

Click "Choose File" and attach your proof of income. You are only able to attach one file at a time. To add additional documents, click "Add another response" in the bottom right corner. 

Please send your proof of income to:

Greater Des Moines Habitat for Humanity
Attn: Rock the Block
2200 E. Euclid Ave
Des Moines, Iowa 50317

Note: Applicants who choose to mail in their proof of income must understand and agree that their application cannot be fully processed until all documentation is received By Habitat for Humanity. Failure to provide the requested documents within a timely manner can result in delays or rejection from the program.