Upgrade: Safe Home Application

Please fill out the form below to detail the level of need and upgrade application

Full Name*

Email*

Phone Contact*

Address of Home Repair or Upgrade Project*

Zip Code*

Applicant own the affected property?*

Yes

No

No, Not Affiliated

Residency*

Primary Residence

Secondary Residence

Rental (Short or Long Term)

Other

Insurance Coverage*

Insured, Fully Covered. Need education on what to do next

Insured, inadequate coverage

Insured, lapse in coverage

Uninsured, self funded. Need help identifying licensed contractors

Uninsured, low income

Uninsured

If not affiliated, or property not owned by applicant; enter owner details below

Description of Upgrade Need*

Notes or Personal Message

Explanation of Necessary Upgrades

Upgrade Application*

Upgrade Grant

Upgrade Loan

Either

Self funded: need education or connect with local rebuid organization

EIN: 99-0435238

Community Leader Resources