Thank you for you interest in applying for Greater Des Moines Habitat for Humanity's Home Preservation Program. Through this program, homeowners, volunteers, and Habitat for Humanity come together to support residents with needed repair, maintenance, weatherization, safety, accessibility, and beautification of homes. By filing out the application below, you will be taking the first steps to qualify for assistance though the Home Preservation Program.

To be considered, applicants must earn between 0 and 60% of the area median income. If accepted into the program, a home assessment will be performed by Greater Des Moines Habitat for Humanity to determine what services are able to be performed and what, if any, repayment is needed. Also, all accepted applicants are asked to complete a minimum of 8 hours of sweat equity.

Due to an abundance of applications the Home Preservation program is currently pausing intakes at this time. You are welcome to complete the application, but please be aware you will be added to our waitlist. We will follow up once our intake has reopened. It may take several months before Greater Des Moines Habitat for Humanity is able to assist you with your repairs. Please select, "Yes" below to confirm that you have read and understand the statement above.

Yes, I understand.

Authorization and Release

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 Home Preservation 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.

Do you understand and consent to the release?

To be considered for Greater Des Moines Habitat for Humanity's Home Preservation program 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 its fight on impoverished housing by keeping the work force volunteer driven.

I am willing to complete the required Sweat Equity:

Greater Des Moines Habitat for Humanity may need to contact you in regards to your application in order to proceed though our Home Preservation program. In order for us to contact you by phone, text message, or email, we require your consent to receive messages from our organization. By responding, you are agreeing and opting in to be contacted and receive messages from Greater Des Moines Habitat for Humanity.

The questions below are requested by our funding providers. The responses you give have no weight in determining your acceptance into Greater Des Moines Habitat for Humanity's homeownership program. Please select "Yes" to indicate the statement is true or "No" if it is false.

I have filed for bankruptcy.

YesNo

I have been convicted of property damage.

YesNo

I have been evicted from a rental unit (including an apartment, home ,mobile home, or trailer).

YesNo

I authorize that all information provided collected in this application is true to the best of my knowledge. I consent to the release of the data collected by this application to all necessary parties involved with the Greater Des Moines Habitat for Humanity Home Preservation Program. By entering my name below, I am agreeing and consenting to the statements above:

Enter your full name here

Date of Acknowledgment

Applicant Contact Information

The information on his application will help us determine if you qualify for the Home Preservation 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).

Applicant

First Name

Last Name

Date of Birth

MM/DD/YYYY

Social Security Number (Last 4 digits)

Street

City

State

Greater Des Moines Habitat for Humanity only serves central Iowa homeowners.

Zip Code

County

Email address

Preferred daytime phone number:

Alternative phone number

Education level

Veteran or Active Duty Military

Race

Ethnicity

Sex

Head of Household

Are you applying with a Co-Applicant?

Applicant Gross monthly income

$

.00

Co-Applicant

First Name

Last Name

Date of Birth

MM/DD/YYYY

Social Security Number (Last 4 digits)

Street

City

State

Zip Code

County

Email address

Preferred daytime phone number:

Alternative phone number

Education level

Veteran or Active Duty Military

Race

Ethnicity

Sex

Co-Applicant Gross monthly income

$

.00

Household Information

Primary language spoken

Are you in need of an interpreter?

Are any individuals with disabilities living in the home?

Will you or anyone in your household require a live-in care attendant?

How many adults live in your home?

How many children live in your home?

How did you hear about the Home Preservation program?

Have your received repairs from Home Preservation / Rock the Block Program in the past?

What repairs were made?

Property Information

Housing Type

Do you live in a neighborhood with an HOA or community with guidelines?

Do you own your home?

Have purchased your home through Greater Des Moines Habitat for Humanity's homeownership program?

Are you current on your mortgage?

Are you current on your property taxes?

Are you buying your home on Contract?

Contract Holder Information

If the applicant has purchased their home under contract and are accepted into the Home Preservation 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.

I understand that I might have to contact my contract holder for permission to make repairs:

Do you expect any additions to your household within the next 12 months?

YesNo

Please explain the addition to your household size:

Is there anyone living with you now who won't be living with you at this property?

YesNo

Please explain the reduction in your household size:

Are there any absent household members who normally would live with you?

YesNo

Please explain their absence:

Household Member Demographics

Please complete the below section for anyone living in the home other than the applicant or co-applicant. To add another person, click "add another response" in the bottom right corner of the page.

First Name

Last Name

Date of Birth

MM/DD/YYYY

Social Security Number (Last 4 digits)

Marital Status

Relationship to applicant

Gender

Race

Ethnicity

Gross monthly income

$

.00

Areas of need

Please select an area of need

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

Please explain:

Priority #1

Priority #2

Priority #3

Additional information:

Have you fallen or do you have a fear of falling in your home?

Do you have an interest in receiving a occupational therapy consultation?

Attach a photo of what you need help with.

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 Home Preservation 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 or email.

Are you currently employed?

How would you like to provide your proof of income?

Uploading proof of income

To determine the eligibility of you application, Greater Des Moines Habitat for Humanity requires all applicants to provide documentation of their income sources. This could include three months of pay stubs, your social security award letter, and /or a disability benefits letter. We also require two of your most recent bank statements. Please use the corresponding upload links below to attach your files. Click "Browse" and attach your proof of income. You are only able to attach one file at a time. To add additional documents, like a second or third pay stub, click "Add another response" in the bottom right corner and repeat the attachment process.

Three months of Pay Stubs

Social Security Letter- SSI

Disability Benefits Letter -SSDI

Two months of Bank Statements

Emailing proof of income

To determine the eligibility of you application, Greater Des Moines Habitat for Humanity requires all applicants to provide documentation of their income sources. This could include three months of pay stubs, your social security award letter, and /or a disability benefits letter. We also require two of your most recent bank statements. If you would like to email your documents, please attach a copy of three months of pay stubs, your social security award letter, and/or your disability benefits letter. We also require two months of bank statements. We would also request that your email includes your name, address, and phone number.

Please use repairs@gdmhabitat.org

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.

Do you understand and agree to emailing in your proof of income?

Mailing proof of income

Please send your proof of income to:

Greater Des Moines Habitat for Humanity

Attn: Home Preservation

PO Box 716

Des Moines, Iowa 50303

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.

Do you understand and agree to mail in your proof of income?