Submit Repair Application

Application Status

Funding Program

Application Current Status

Denied Reason

Incomplete Reason

Denied Notes

Application Dates

Received Date

Denied Date

Incomplete Date

In Scope Date

In Process Date

Closed Pending Date

Completed Date

Property Address

Address

City

State

Zip

County

Applicant Information

First Name

Middle Initial

Last Name

SSN

Birthdate

Phone 1

Phone 2

Homeowner Email

Marital Status

Contact Notes

Applicant Address

Apartment Complex Name

Street

City

State

Zip

County

Years at Address

Previous Applicant Address

Street

City

State

Zip

County

Rent or Own

Years at Address

Co-Applicant Information

Number of Co-Applicants

Co-Applicant First Name

Co-Applicant Middle Initial

Co-Applicant Last Name

SSN

Co-Applicant DOB

Co-Applicant Phone 1

Co-Applicant Phone 2

Co-Applicant Email

Marital Status

Co-Applicant Address

Apartment Complex Name

Street Address

City

State

Zip

County

Rent or Own

Years at Address

Previous Co-Applicant Address

Street

City

State

Zip

County

Rent or Own

Years at Address

Other Residents in Home

Name of Other Resident 1

SSN of Other Resident 1

DOB of Other Resident 1

Gender of Other Resident 1

Relationship to Other Resident 1

Name of Other Resident 2

SSN of Other Resident 2

DOB of Other Resident 2

Gender of Other Resident 2

Relationship to Other Resident 2

Name of Other Resident 3

SSN of Other Resident 3

DOB of Other Resident 3

Gender of Other Resident 3

Relationship to Other Resident 3

Name of Other Resident 4

SSN of Other Resident 4

DOB of Other Resident 4

Gender of Other Resident 4

Relationship to Other Resident 4

Name of Other Resident 5

SSN of Other Resident 5

DOB of Other Resident 5

Gender of Other Resident 5

Relationship to Other Resident 5

Name of Other Resident 6

SSN of Other Resident 6

DOB of Other Resident 6

Gender of Other Resident 6

Relationship to Other Resident 6

Name of Other Resident 7

SSN of Other Resident 7

DOB of Other Resident 7

Gender of Other Resident 7

Relationship to Other Resident 7

Name of Other Resident 8

SSN of Other Resident 8

DOB of Other Resident 8

Gender of Other Resident 8

Relationship to Other Resident 8

Referral Information

How did you hear about us?

How did you hear about us - Another Agency

How did you hear about us - Another Habitat Repair Program Participant

How did you hear about us - Other

Present Housing Conditions

Number of Bedrooms

Number of Bathrooms

Does Rent Include Utilities

Utility Statement Provided

Monthly Rent Amount

Is Rent Subsidized

Applicant Landlord Information

Name of Current Landlord

Landlord Phone

Landlord Street Address

Landlord City

Landlord State

Landlord Zip

Years at Address

Previous Landlord

Name of Previous Landlord

Landlord Phone

Landlord Street Address

Landlord City

Landlord State

Landlord Zip

Co-Applicant Landlord Information

Name of Current Landlord

Landlord Phone

Landlord Street Address

Landlord City

Landlord State

Landlord Zip

Years at Address

Previous Landlord

Name of Previous Landlord

Landlord Phone

Landlord Street Address

Landlord City

Landlord State

Landlord Zip

Funding Source

Annual Income Summary

At Application totals will continue to update based on the entered income only when the application status is Received, Incomplete, or Denied. Closing totals will update until the status reaches Closing Process.

Monthly Income Summary

At Application totals will continue to update based on the entered income only when the application status is Received, Incomplete, or Denied. Closing totals will update until the status reaches Closing Process.

Household Income (Monthly)

How many other residents in the home have income?

Applicant Name

Wages - Applicant

SS, SSDI, SSI - Applicant

Temporary Assistance - Applicant

VA Benefits - Applicant

Child Support/Alimony - Applicant

Child Support Name(s) - Applicant

Payments from Trusts, Annuities, Retirement, Pensions - Applicant

Rental Income - Applicant

Monthly income from other sources - Applicant

CoApplicant Name

Wages Resident - CoApplicant

SS, SSDI, SSI Resident - CoApplicant

Temporary Assistance - CoApplicant

VA Benefits - CoApplicant

Child Support/Alimony - CoApplicant

Child Support Name(s) - CoApplicant

Payments from Trusts, Annuities, Retirement, Pensions - CoApplicant

Rental Income - CoApplicant

Monthly income from other sources - CoApplicant

Name - Other Resident 1

Wages - Other Resident 1

SS, SSDI, SSI - Other Resident 1

Temporary Assistance - Other Resident 1

VA Benefits - Other Resident 1

Child Support/Alimony - Other Resident 1

Child Support Name(s) - Other Resident 1

Payments from Trusts, Annuities, Retirement, Pensions - Other Resident 1

Rental Income - Other Resident 1

Monthly income from other sources - Other Resident 1

Name - Other Resident 2

Wages - Other Resident 2

SS, SSDI, SSI - Other Resident 2

Temporary Assistance - Other Resident 2

VA Benefits - Other Resident 2

Child Support/Alimony - Other Resident 2

Child Support Name(s) - Other Resident 2

Payments from Trusts, Annuities, Retirement, Pensions - Other Resident 2

Rental Income - Other Resident 2

Monthly income from other sources - Other Resident 2

Name - Other Resident 3

Wages - Other Resident 3

SS, SSDI, SSI - Other Resident 3

Temporary Assistance - Other Resident 3

VA Benefits - Other Resident 3

Child Support/Alimony - Other Resident 3

Child Support Name(s) - Other Resident 3

Payments from Trusts, Annuities, Retirement, Pensions - Other Resident 3

Rental Income - Other Resident 3

Monthly income from other sources - Other Resident 3

Name - Other Resident 4

Wages - Other Resident 4

SS, SSDI, SSI - Other Resident 4

Temporary Assistance - Other Resident 4

VA Benefits - Other Resident 4

Child Support/Alimony - Other Resident 4

Child Support Name(s) - Other Resident 4

Payments from Trusts, Annuities, Retirement, Pensions - Other Resident 4

Rental Income - Other Resident 4

Monthly income from other sources - Other Resident 4

Aging in Place
AHP/FHLB
AmeriCorps National
AmeriCorps VISTA
ARPA OH
Campus Chapter
Capacity Building Section 4
Carol M Peterson
Clermont – RRP
Colerain
Community Development Block Grant (CDBG)
Department of Energy
Disaster Preparedness (proactive)
Disaster Response & Recovery (reactive)
Faith Engagement (non-Thrivent)
FlexCAP
General Funding FY26
Habitat Homeowner
Habitat KY
Hamilton – RRP
Home Builders’ Blitz
Home Depot
Home Investment Partnership Program (HOME)
Lead Safe OH
Local Housing Trust Fund
Lowes
Neighborhood Stabilization Program (NSP)
New Market Tax Credits (HFHI and off-line)
Newport
R+T City
R+T County
Repair Corps
Self-Help Homeownership Opportunity Program (SHOP)
Standard Affiliate Build
State Housing Trust Fund
Thrivent Builds Homes
USDA 502
USDA 504
Veteran
Veterans Build
Veteran Trust Fund - KY
Women Build
No Funding Source

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