THERE IS NO GUARANTEE OF SERVICE BY APPLYING TO REBUILDING TOGETHER AURORA

Transcription

1 Rebuilding Tgether Aurra 37 S River St Aurra, IL Office Line: (630) Fax Line: (630) Dear Hmewner: Rebuilding Tgether Aurra (RTA) is a safe and healthy husing rganizatin which utilizes skilled and general vlunteers t prvide hme repairs fr qualified, lw-incme hmewners. RTA prvides these services at n cst t qualified hmewners. RTA Qualificatins fr services: 1. The prperty must be wner ccupied and be the primary residence 2. The prperty may nt be fully rented. Hwever, if the hmewner is cllecting rental incme fr a prtin f the hme, this may be acceptable. Rental incme must be cnsidered as incme and evidence prvided as part f the dcumentatin requirements. 3. The incme must fall within r belw 80% f the HUD Lw-Incme standards. 4. The hmewner must be an elderly persn; a persn with disabilities r wh cares fr; a veteran; r a parent/guardian with child(ren) 18 r under living in the hme. 5. The hmewner is nt able t d necessary repairs/mdificatins due t cst r physical cnstraints Husehld size Annual incme 1 persn $42,600 2 peple $48,650 3 peple $54,750 4 peple $60,800 5 peple $65,700 6 peple $70,550 7 peple $75,400 In rder fr RTA t determine yur eligibility an applicant must cmplete the Hmewner Applicatin and prvide the fllwing dcumentatin that indicates: 1. Prf f wnership via Title, Warranty Deed r Prperty Tax bill 2. Current incme verificatin, including ttal husehld incme f all persns living in the hme a. Mst recent 30 days f pay stubs (if applicable) fr all persns b. Mst recent filed tax return fr all persns c. A cpy f yur bank statement displaying public assistance, if applicable 3. Evidence that the Hmewners insurance plicy is in frce 4. Evidence that all mrtgage payments are current ONCE APPLICATION IS SUBMITTED YOU WILL BE NOTIFIED BY MAIL ABOUT THE STATUS OF YOUR APPLICATION. PLEASE UNDERSTAND THAT IT MAY TAKE SOME TIME TO HEAR BACK FORM US. THERE IS NO GUARANTEE OF SERVICE BY APPLYING TO REBUILDING TOGETHER AURORA T help with the safety f yur hme, if yu re applying fr a rf r weatherizatin needs, we highly recmmend als applying t: Jseph Crpratin Suth Bradway Aurra, IL Prvides funding fr prjects that increase energy efficiency, such as rfs and furnaces Cmmunity Cntacts S. Hawthrne St. Elgin, IL Prvides weatherizatin needs fr eligible hmes

2 RTA has 2 primary services and ne annual rebuilding event. I. SAFETY AND ACCESSABILITY SERVICE SAFE AT HOME Thrugh the Safe at Hme prgram, Rebuilding Tgether Aurra prvides n-cst, hme safety and accessibility mdificatins fr lw-incme hmewners wh are senirs, living with a disability r caring fr a lved ne with a disability. Safe at Hme Prgram apprved repairs: Mbility Repairs Aging in place Safety Repairs Flring replacement Hand railings Accessibility ramps Brken r weak steps Grab bars ADA accessible drways Walk-in shwer ADA height tilet Shwer chairs Lever dr knbs Lever faucets Additinal lighting Electrical failures --unsafe r fire hazards Chimney tuck-pinting/flashing Mld frm water damage Smke detectrs/c2 detectrs Dead blts & lcks Peep hles Exterir drs Brken windws II. GENERAL REPAIR SERVICE Vlunteer based service where we engage crprate, faith based, and civic grups in prviding a range f repairs, based n their skill level, during a special day f service during the year. Hmewners that d nt qualify r wh are seeking nn Safe at Hme services will be placed n a waiting list fr this service prgram. Because these services are prvided thrugh vlunteers there is n guarantee f service. RTA can nly serve as many hmewners as resurces allw. Hmewners that fall within the bundaries f annual rebuilding events that RTA hsts will be ntified and services prvided thrugh thse events. III. ANNUAL APRIL REBUILDING EVENT COMMUNITY BLOCK BUILD Thrugh an annual Cmmunity Blck Build, taking place during the last weekend f April, Rebuilding Tgether Aurra prvides n-cst, larger scale hme repairs fr targeted hmes in a neighbrhd that has been selected by RTA. This prgram takes a blck-by-blck, huse-by-huse apprach t imprving the health and well-being f lw-incme husehlds. ALL WORK COMPLETED BY REBUILDING TOGETHER AURORA IS NOT WARRANTIED. T submit this applicatin please scan and t shay.lsn@rtaurra.rg, r yu can call the ffice t make an appintment fr drp ff r pick up.

3 Rebuilding Tgether Aurra 37 S River St Aurra, IL Office Line: (630) Fax Line: (630) T submit applicatin please scan and t shay.lsn@rtaurra.rg, r yu can call the ffice t make an appintment fr drp ff r pick up. Office Use Only: Received n: Applicatin # FOIA Requested/Cmpleted: / 1. HOMEOWNER INFORMATION Name f Applicant: Age: Sex: F M Street Address: Zip Cde: Disabled: Phne # Alternate Phne # Name f Primary Cntact (if nt hmewner) Relatinship: Phne # Marital Status: Married Living with a partner Divrced/separated Widwed Single/never married Race: African American/Black Asian American Indian/Alaskan native Pacific Islander White/Caucasian Ethnicity: Hispanic/Latin Nt Hispanic /Latin Other(Please Specify) Hw many years have yu lived in yur hme? D yu have a mrtgage n the hme? Are there renters in the hme? D yu wn yur prperty? If yes, are payments up t date? Is this hme yur nly residence? Is this hme in the histric district? Name f district: Have yu been cited by the city fr any husing cde vilatins? (Please Prvide a cpy f the citatin with applicatin) Fr: Are yu a previus applicant f Rebuilding Tgether Aurra r Christmas in April? When: Hw did yu hear f Rebuilding Tgether Aurra? (Please circle) Flyer TV Newspaper Alderman Senir Center Friend/Neighbr Other:

4 II. RESIDENTS INFORMATION (Cmplete the fllwing fr ALL members f husehld) Name: Age: Relatinship: Ethnicity/Race: Disabled: Name: Age: Relatinship: Ethnicity/Race:: Disabled: Name: Age: Relatinship: Ethnicity/Race: Disabled: Name: Age: Relatinship: Ethnicity/Race: Disabled: Name: Age: Relatinship: Ethnicity/Race: Disabled: III. DISABILITY/CHRONIC ILLNESS INFORMATION (Please check what disabilities apply t the residence f the hme?) Mbility Health Impairment Hearing Impairment Mental Disability Sight Impairment Other If ther was selected please describe: Des anyne in the hme suffer frm a chrnic illness? Please describe: D yu have caregiver that cmes t the hme? IV. MILITARY BACKGROUND INFORMATION Are yu a Veteran r is/was yur Branch f Service: Dates f Service: spuse a Veteran? Is anyne else listed as living in the hme a Veteran? Wh: Branch f Service: Dates f Service: Is anyne in the hme currently serving in the Armed Frces? Wh: Branch f Service: Dates f Service: V. VERIFICATION OF ANNUAL INCOME (Please add ALL incme surces fr all member in the husehld 18 years f age and lder : (All incme surces shuld be included emplyer, self emplyment, unemplyment, pensins, VA benefits, disability benefits, Scial Security, SSI, SSIE, AFDC, Medicare, Medicaid, child supprt, fster care, adptin assistance, rental incme, etc.) Please attach prf f these dcuments with applicatin when submitted) Annual Salaries and Wages $ Rental Incme $ Pensins, Retirement, Death Benefits $

5 Scial Security Benefits $ Unemplyment, Disability, and Wrkman s $ Cmpensatin Other (Child Supprt, TANF, Military Cmp, etc) $ Ttal $ VII. HOMEOWNER REQUESTED REPAIRS RTA priritizes ur effrts twards safe and healthy hme repairs. Remember that the items listed belw will be cnsidered fr repair, but the final decisin n what wrk can be dne n yur hme with cnsideratin f vlunteer and financial resurces will be made at the discretin f RTA. Attach a separate piece f paper if there is nt enugh space t list all repairs. Please nte that these are requests and we cannt prmise r guarantee assistance r the extent f repairs dne. I have read the abve statement and understand that there is n guarantee f service What is the nature f the prblem(s) fr which yu are requesting assistance? General: Insulatin Plumbing Repairs Appliances Carpentry Repairs Electrical repairs Drs/Windws Rfing Repairs Painting Accessibility Mdificatins: Ramp Lw Rise Steps Grab Bars Walk In Shwer VIII. HOMEOWNER S PRIORITY REPAIRS ( Please list yur tp-pririty repairs fr the hme)

6 IX. HOMEOWNER AGREEMENT (Please read and initial next t each statement) I understand that Rebuilding Tgether Aurra (RTA) is funded by charitable dnatins and grants t prvide assistance t lw-incme senirs, veterans, disabled hmewners, r families with children wh have n ther means t affrd hme repairs. I understand that RTA des nt guarantee service, regardless f applicatin status r hmewner eligibility. I have n intentin f selling this hme r transferring wnership f this hme within three years f the signature date f this dcument. I authrize Rebuilding Tgether Aurra and its representatives t cmplete any required paperwrk fr btaining building permits that may be necessary t repair my hme. I understand that Rebuilding Tgether Aurra is a neighbr-helping-neighbr rganizatin, and I will d everything pssible t get family and friends t help me. I understand that, in the presence f Rebuilding Tgether Aurra vlunteers, the use f alchl, sale r use f drugs ther than as prescribed by a dctr, r any behavir which threatens r creates discmfrt t the vlunteers n my/ur part r the part f my/guests r family is cause fr immediate cancellatin f all scheduled wrk at my hme. I further authrize Rebuilding Tgether Aurra and its representatives t cnduct such investigatin as it deems necessary t cnfirm the safety f its vlunteers, including the use f criminal backgrund checks, the prcurement f cnsumer reprts, and the cnsultatin with the lcal plice department as t plice reprts at the residence. The infrmatin being btained will nt be used in vilatin f any federal r state equal pprtunity law r regulatin. I certify that the abve infrmatin is true and crrect t the best f my/ur knwledge. I als authrize yu t check any references necessary t cmplete the prcessing f this applicatin fr the purpse f receiving husing rehabilitatin thrugh Rebuilding Tgether. I als understand that this infrmatin will be kept cnfidential and will be used strictly fr the purpse f determining my/ur eligibility fr the Rebuilding Tgether prgrams. I have included the fllwing dcuments with this applicatin (REQUIRED): Prf f wnership via Title, Warranty Deed r Prperty Tax bill Current incme verificatin, including ttal husehld incme f all persns living in the hme Evidence that the Hmewners insurance plicy is in frce Evidence that all mrtgage payments are current Signature f Applicant Date Printed Name Preparer Signature (if nt hmewner) Date Printed Name Phne Relatinship Rebuilding Tgether Aurra des nt discriminate against, nr exclude frm participatin, any applicant fr assistance n the grund f their race, clr, religin (creed), sex, age, disability, sexual rientatin, ancestry, natinal rigin, citizenship status, r any ther basis prhibited by applicable law.