Apply for Assistance

Homeward Foundation Assistance Application

Notes for Prioritization:

Applicants with severe safety or accessibility issues.
Applicants must have homeownership of home requesting assitance.
Households with vulnerable members (e.g., elderly, disabled, or young children).
Recent medical conditions or disabilities that create a need for home modifications.
Applicants facing financial hardship, such as overwhelming medical bills, or unexpected unemployment.

Online Application

We highly recommend filling out this form on a desktop computer screen.

Your First Name: *

Your Last Name: *

Are you filling this form out for yourself?

Yes No

Name of Recommended Party:

Phone Number: *

Email Address: *

Home Address:

City:

State:

Zip Code:

Your Age:

# of People Living in the Household:

Names and Ages of Household Members:

Do you own the home where repairs are being requested?

Yes No

If "No" – please explain your situation:

How long have you owned the home?

Is your home currently insured?

Yes No

If "No" – please explain your situation:

Are you current on your mortgage payments?

Yes No

If "No" – please explain your situation:

Total Monthly Household Income:

If "Other" – please explain:

Do you currently receive any form of public assistance?

Yes No

If "Yes" – please specify:

Please describe any financial hardships you are facing:

Do you or any household members have medical conditions or disabilities that impact your ability to live safely in your home?

Yes No

If "Yes" – please describe the condition(s) and how they affect daily living:

Has a healthcare professional recommended modifications or repairs to your home to accommodate your medical needs or physical limitations?

Yes No

If "Yes" – please explain, and attach any documentation if available:

Upload up to 5 (five) supporting documents:

Are there any accessibility modifications that need to be made (e.g., ramps, walk-in showers, handrails)?

Yes No

If "Yes" – please describe the specific needs

Have you had any recent hospitalizations or medical treatments that have impacted your financial situation?

Yes No

If "Yes" – please explain the situation

Please describe the current condition of your home and the specific repairs or renovations you are requesting:

How long have these issues been present?

What, if any, attempts have been made to repair these issues in the past?

How do these issues affect your daily living and the safety of your home?

Do you have any photos or documentation of the needed repairs?

Yes (please attach) No

Upload up to 5 (five) Documentation

Why do you believe the Homeward Foundation is the right organization to assist you with these repairs?

Would you be willing to have your home visited for an inspection and assessment of repair needs?

Yes No

Would you be open to having your story shared (with your permission) for the purposes of raising awareness or fundraising for the Homeward Foundation?

Yes No

Verification Certfication

By submitting this application, I certify that the information provided is true and accurate to the best of my knowledge.

Please Type Your Name for Certification:

Today's Date:

Please provide the following supporting documents:

Proof of homeownership (e.g., mortgage statement or deed)
Proof of income (e.g., pay stubs, benefits statement)
Medical documentation if home modifications are medically necessary (optional but helpful)
Photos of the areas in the home needing repair

Additional Supporting Documents:

Communications Acceptance

I agree to receive notification and communications from Homeward Foundation.

What to expect after you’ve applied:

Stay Tuned!

Thank you for applying to Homeward Foundation! Once your application is submitted, our team will carefully review your request to assess eligibility and urgency. Within 48 hours, we will contact you to discuss your needs, gather any additional information, and schedule an initial home assessment if necessary.

Our goal is to prioritize those with the most urgent repairs and financial hardships, ensuring we can provide the best possible assistance.

If selected, we will work closely with you throughout the renovation process, keeping you informed every step of the way.

No matter the outcome, we are here to support you and connect you with resources that can help.

Apply for Assistance

Homeward Foundation Assistance Application

Notes for Prioritization:

Online Application

What to expect after you’ve applied:

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