Home Repair Application Form

Home Repair Application Form
This form is for home repair organizations applying for City funds to perform home repairs for low-income households within the city limits. Applications are due by the Notice of Funding Opportunity Deadline. Staff will confirm receipt of applications within 3 business days. If you need assistance or have questions, please contact Affordable Housing staff at affordablehousing@ashevillenc.gov.
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Please sign the Applicant Certification & Authorization form.

If your application is a partnership, each organization must sign the form. Please share the link with the other organiztaions, or send the form to them using this form.

After signing the Applicnt Certification & Authorization form, please return to this page to continue your application.
Have you submitted the Applicant Certification, Authorization & Disclosure?
Please sign the Applicant Certification & Authorization form.

If your application is a partnership, each organization must sign the form. Please share the link with the other organizations, or send the form to them using this form.

After signing the Applicant Certification & Authorization form, please return to this page to continue your application.

Applicant Name

First NameLast Name
Doing Business As (If Applicable)
Type of Organization
Applicant/Organization Established Date

MonthDayYear
Contact Name

First NameLast Name
Title / Position
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Federal ID #:
Are you applying together with one or more organizations?
If Yes, please list those organizations here, and note which organization will hold the funds and act as the lead entity:

Amount of Home Repair Funds Requested:
Target number of households to be served:
Will other funds be used to match (or in combination with) City funds?
What is the overall dollar amount cap your organization will spend on a single home repair?
Project Narrative
Provide enough detail to allow staff to fairly assess your program.
The Home Repair Policy states that the following populations will be prioritized:
- Households with incomes at or below 60% of Area Median Income
- Households with Seniors, Families with children and/or persons with disabilities
- Long term households facing involuntary displacement
- Neighborhoods identified as vulnerable to displacement
How will your program prioritize these populations? Cite specific methodologies/strategies:
How do you intend to reach out to potential homeowners?
Describe your program's past experience with home repair:
Do you have a current waiting list for home repair?
If yes, how number of households on the waiting list?
What types of repairs will you offer in your program?
How will you measure success?
Name specific Outcomes and Outcome Measurements.

Project Budget
You have the option of completing and attaching the budget using the City of Asheville Home Repair Program Budget Template or entering the budget directly into this application. Please use the field below to indicate your preference.
How are you submitting your budget?

Administrative Costs will be considered up to 15% of the total budget, depending on the number of organizations on an application.
Total of City Funds Requested
Other leveraged Funds
Total Program / Project Budget
Budget:

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Declaration
I certify that the information provided on this form is true, complete, and accurate to the best of my knowledge. By checking this box and typing my full name below, I am providing my electronic signature.
Full Legal Name
(Required for Signature)
Date Signed

MonthDayYear
Should be Empty:

Rows	Budget Item	Calculation	Tot of City Funds Requested	% of Budget	Other leveraged Funds	Total Program/Project Budget
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Documents/Attachments Needed: