Thank you for your interest in our Critical Home Repair program! To receive an application your information will need to be added onto our Interest Form. Your property will be pre-screened based on basic property requirements for our Critical Home Repair program. Should your property pass the initial screening, you will be notified when applications will become available to you.  

Filling out this form does not qualify you for our Critical Home Repair program and does not guarantee that you will be served through our program.  

If you have any questions, please call our Critical Home Repair hotline: 828-733-1909

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IS THIS A CRITICAL HOME REPAIR INTEREST FORM FOR YOURSELF OR A REFERRAL FOR SOMEONE YOU KNOW? *

• MYSELF
• SOMEONE ELSE

SHOULD SOMEONE A

HOMEOWNER NAME *

First

Last

PHONE *

Email

NAME OF PERSON COMPLETING THE FORM (IF DIFFERENT FROM THE HOMEOWNER)

First

Last

PHONE

Email

WHO SHOULD WE USE FOR THE PRIMARY CONTACT? *

• HOMEOWNER
• PERSON WHO FILLED OUT THE FORM

HOME ADDRESS *

CITY, STATE, ZIP CODE *

PREFERRED LANGUAGE *

• ENGLISH
• SPANISH

ARE YOU A VETERAN OF THE US ARMED FORCES *

• YES
• NO

Submit