Roof Repair Application

Newburgh Homeowner Roof Repair Program Application
Newburgh Homeowner Roof Repair Program

for City of Newburgh Owner Occupied Single Family Homes
Homeowner Roof Repair Program is a program of Habitat for Humanity of Greater Newburgh’s Neighborhood Revitalization Initiative (NRI) in partnership with the City of Newburgh.

Scope of Services

Habitat for Humanity of Greater Newburgh (Habitat Newburgh)will facilitate roof repairs/replacements of low/moderate-income owner-occupied homes in the City of Newburgh. Habitat Newburgh’s repair/replacement initiative, allowing up to $12,500 to be used for roof repair/replacement projects will be administered in the same manner as Habitat Newburgh’s Homeownership Program, where project approval is contingent upon each recipient’s ability to meet HUD income guidelines. Each homeowner will be required to provide income statements and will assume responsibility for any costs beyond $12,500.

These services are provided by Habitat for Humanity of Greater Newburgh at an affordable cost to the homeowner. If you meet the requirements listed in the Applicant Eligibility section below please proceed and fill out the Roof Repair Application.

This application, including the requested documents, will be reviewed by Habitat for Humanity of Greater Newburgh staff. If the application and materials provided meet our program criteria and the project is within Habitat’s resources, your application will be reviewed and considered with other qualifying applications. Incomplete applications will not be considered.

Chosen recipients for a Roof Repair Project, will be notified by phone by a representative of Habitat for Humanity of Greater Newburgh. A home visit will then be scheduled to conduct an assessment of the repairs requested and work will begin once the homeowner and Habitat agree on the Scope of Work and a Work & Payment Agreement. Completing this application does not guarantee project approval or acceptance into the program.

If you have any questions or concerns regarding this application or the process, please call (845) 568 - 6035 ext. 104 or email callen@habitatnewburgh.org.

Thank you for your interest in partnering with Habitat for Humanity of Greater Newburgh.

Applicant Eligibility
- Applicant must be the homeowner residing in a single-family house that is no more than 2.5 stories high
- House must be the primary place of residence
- Applicant must have lived in Habitat Newburgh’s service area for at least 1 year
- Applicant must meet household income guidelines [up to 80% of the area median income]
- Applicant must be willing to agree to the Work & Payment Agreement
Payment Agreement/ Fees

Fee: $75 Household income up to 49% of Area Median Income

Fee: $150 Household income 50-80% of Area Median Income
Homeowner Information
Owner Name*

First NameLast Name
Owner Date of Birth*

MonthDayYear
Date
Co-Owner Name

First NameLast Name
Co-Owner Date of Birth

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Household Members (used to determine household size)

List names and date of birth and relationship of ALL people living in the household
First Name   Last Name   Date of Birth
First Name   Last Name   Date of Birth
First Name   Last Name   Date of Birth
First Name   Last Name   Date of Birth
First Name   Last Name   Date of Birth
First Name   Last Name   Date of Birth
First Name   Last Name   Date of Birth
Is anyone in your household a veteran or serving in the military?

YesNo
Special Needs
Is anyone in your household disabled?

YesNo
If yes, please describe below.
Is translation needed?

YesNo
If yes, what language?
Information Referral-- If your application is a more appropriate fit with similar programs of other organizations, may we share it with them on your behalf?

YesNo
Household Income

Indicate in the spaces provided below, the monthly income of all residents of the home, including the homeowner/s and other adults over the age of 18 years old, unless they are a student and student status can be shown.

Roof Repair Application

Page 2
Basic House Information
What size isyour house:

1 story1.5 story2 story2.5 story
Year Purchased
Year Built
Media & Publicity
Where/How did you learn about A Brush With Kindness?
If A Brush With Kindess selects your home to be repaired, pictures of you and/or the outside of your home may be taken. By signing and submitting this application, you are granting Habitat for Humanity of Greater Newburgh permission to usethese photos and videos in promotional and marketing materials for the program unless otherwise noted below.

Deny Permission
Homeowner Agreement
I certify that the information on this application and in the attached documents and worksheets is accurate tothe best of my knowledge. I further certify that I own the property at the address given on this application. Ihave no present intention to move or offer my home for sale for at least three years. I confirm that any physicallyable persons residing in my home or visiting for the project day(s) will work alongside ABWK volunteers.I confirm that, except for the conditions attached, my home is a safe place for volunteers.To the extent permitted by law and without affecting the coverage provided by the required homeowner’sinsurance, I agree to sign and release a waiver of liability.
Owner signature

Clear
Co-Owner Signature (if applicable)

Clear
Document Uploads
Upload a copy of the deed/title on your home or other proof of ownership such as property tax receipt. (Alldocuments submitted must show the name and address of the applicant.)
Attach a copy of your current homeowner's insurance
Upload a statement verifying income for each household member employed? This statement can be a copy of one or more of the following: tax return, social security receipts, retirement pay receipts, or other documentation of household income. All adults over theage of 18, must submit an income document or prove current student status.
Application Check List
If you have any questions or concerns regarding this application or the process, please call (845) 568 - 6035 ext. 104 or email callen@habitatnewburgh.org.

Thank you for your interest in partnering with Habitat for Humanity of Greater Newburgh.

Completing this application does not guarantee project approval or acceptance into the program.
Should be Empty:

Newburgh Homeowner Roof Repair Program Application

Newburgh Homeowner Roof Repair Program

Homeowner Information

Household Members (used to determine household size)

Special Needs

Household Income

Roof Repair Application

Basic House Information

Media & Publicity

Homeowner Agreement

Document Uploads

Application Check List