Aging in Place – Critical Home Repair

Enabling seniors to age safely, independently, and comfortably in their homes.

Why Home Repair?

By providing affordable home repairs, Aging in Place preserves home ownership and gives older adults the choice of where they grow older. Our skilled construction staff and group of volunteers perform work to alleviate critical health, life, and safety issues for homeowners in need. These changes help preserve older adults’ dignity by providing services and support that enables them to remain independent and engaged in their community.

Are you in need of critical home repair?

If interested, please fill out our interest form below. For more information, contact Habitat at (707) 578-7707 or email [email protected].

Am I eligible?

You may qualify for the AIP program if you meet all the following criteria:

• You own and live in your own home, full-time.
• You are age 60 or over, or someone in your home is.
• Your city and property taxes are current.
• Your mortgage is current.
• You meet the income guidelines for the program, based on your income and the income of everyone else who lives in your home: (see chart below for specific income ranges)

2020 Maximum Income depends on the number of people in your household, not including fulltime caregivers.

What’s the cost?

• We use volunteer labor and donated materials to keep costs low.
• The cost of materials will be shared between the homeowner and Habitat. The homeowner’s portion of the shared cost will be determined based on financial situation.

What work is done?

The work done will be based on your requests and the recommendations made by Habitat for Humanity’s Aging in Place team.

Examples of work that may be provided includes:

• Modifications to improve mobility, accessibility, and safety, such as grab bars, wheelchair ramps, and widened doorways.
• Minor repairs, such as wall repair and painting, decking, window replacement, and fencing.

Aging in Place Home Repair Interest Form

HOMEOWNER CONTACT INFORMATION

Name of homeowner:

Date of Birth:

Phone Number:

Alternate Phone:

Home

Mobile

Email Address:

Preferred Language:

Address:

City:

ZIP:

Race:

Please select...American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhiteprefer not to answer

Ethnicity:

Please select...Hispanicnot Hispanicprefer not to answer

Marital Status:

Please select...SingleMarried/Domestic PartnershipDivorcedSeparatedWidowed

	Yes	No
Did you or your spouse serve in the U.S. military?

Case Manager or Other Contact?:

Contact Information:

HOME RESIDENT INFORMATION

Please list all individuals living in the home, including children and renters.

NAME	RELATIONSHIP TO HOMEOWNER	AGE

Do any of these individuals have special needs? If so, who?

HOMEOWNER INFORMATION

	Yes	No
Do you own your own home?

How many years have you lived in your home?

What year was your home built?

Describe your home:

Single Family HomeCondoDuplex/TriplexMobile HomeOther

If other, please describe:

How many bedrooms do you have in your home?

Do you have any outstanding loans on your property? If so, what is the total amount?

	Yes	No
Is the home in Sonoma County?
Is the home your primary residence?
Are you current on your property taxes?
Are you current on your mortgage?
Do you have CURRENT homeowner's insurance?
Do you plan to sell your home in the near future?
Would you be comfortable with a team of 20 volunteers working in your home at a time?
Have you participated in this program in the past? (returning clients will not be excluded)

Do you have any pets? If yes, list the types and number of each type:

Do you receive services from any social agencies or do you participate in any senior organizations?
Example: Meals on Wheels. (Receiving services from other social agencies will NOT disqualify you from Habitat for Humanity. These questions help us know more about how we might be able to serve you).

If so, Program Name(s):

Do you work? If so, what is your job?

What is your annual income?

What is your primary source of income?

Do you have any savings/investments? If so, how much?

Does another resident of your home contribute to the household income?

If so, how much?

What is their job?

HOMEOWNER REPAIR PRIORITIES

What are your top 4 priorities for repair or help?

1.

2.

3.

4.

Additional projects you might like help with:

Any other information you think we should know while we consider your request for service?

How did you hear about Habitat for Humanity's Aging in Place program?

HOME HEALTH AND SAFETY NEEDS

These priorities help focus attention on significant health and safety hazards around your home and help us establish an overall picture of your current living conditions and how we might be able to help you.

	Yes	No
Are all the stairs and decks safe in both the front and the back?
Do you have good lighting outside?
Is your home's exterior clear of tripping hazards?
Are your windows and exterior doors functional and secure?
Does your house have functional gutters and downspouts?
Is your house free of active leaks and moisture?
Is your clothes dryer vented to the outside?
Is your home free of wide cracks or gaps outside?
Is your home free of pests and/or rodents?
Do you often use your backyard or garden?
Would you benefit by removing unwanted items from your garage or yard?
Is your exterior paint in good condition?

Do you have any further comments?

I certify that to the best of my knowledge, the information provided in this application is correct.

Signature (print name):

Date:

Thank you for applying to Habitat's Aging in Place Critical Home Repair program. The application is a multi-step process. Qualification will be based upon need and willingness to partner. You will be contacted, following the review of your application.

Habitat for Humanity of Sonoma County does not discriminate on the basis of race, color, national origin, religion, sex, age, family status or marital status, disability, sexual orientation, gender identity, or because all or part of the program is derived from any public assistance program.

Contact Information