Home Repair Sign Up Form

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Home Repair Intake Form

To find out if your home qualifies, or to obtain an application, fill out the Intake Form below, or contact Mark Odenwelder at 973-891-1934, home.repair@morrishabitat.org.

First Name**

Last Name**

Email Address**

Address, line 1**

Address, line 2

City**

State**

Cell Phone**

Zip Code**

How you heard about the Home Repair program?

Please answer the following questions about your home and your household

Total household members*

Number of adults

Age of oldest resident **

Number of Children under 18

1. Do you own the home/can show proof that you are paying the mortgage for the property?

Yes No

2. Are your property taxes paid and up to date?

Yes No

3. Is the property in foreclosure?

Yes No

4. Are you in bankruptcy?

Yes No

5. Do you plan to stay in the home?

Yes No

6. Do you have homeowner's insurance?

Yes No

7. Do you own more than one home?

Yes No

8. What is your household GROSS income (income before taxes are withheld)?*

9. What are your total assets? (must be less than $173,843, not including home)

10. What work is needed on your home?*

Sign up

Thank you for signing up.

We can't wait to start building our partnership!

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