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Critical Home Repair Interest Form
Habitat Anchorage plans to offer critical home repair program this summer. At this time, we are only able to accept inquiries. Filling out the interest survey does not guarantee that we will be able to assist you. Please check the qualifications on the Web page before filling out the form.
Habitat for Humanity - Anchorage is currently only able to operate in the Municipality of Anchorage. Is your home located in Anchorage?
Yes
No
If you select "No," you do not meet the qualifications for this program.
Are you the homeowner?
*
Yes
No
If you select "No," you do not meet the qualifications for this program.
Does your project require any mold or rot remediation and/or contact with asbestos or lead?
*
Yes
No
If you select "Yes," you do not meet the qualifications for this program.
What kind of home do you own
*
Single Family Standard Construction
Duplex or Multi Family Complex
Mobile Home
Other
If you select "Mobile Home," you do not meet the qualifications for this program.
What are your repair needs?
*
The selection process and project implementation will take time.
If you require urgent assistance, please consider exploring other programs or calling to United Way: 211 for support.
Name
*
Address
*
Phone
*
###
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###
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####
Email Address
*
Please Mark All That Apply
*
Home owner is aged 65+
Home owner is military/ veteran
A member of the household has a disability
Home owner is income - COVID affected
Home owner has other special circumstances listed below
Special Circumstances not listed above
