Please read all questions carefully and complete the entire application.

If you need assistance, please contact our Family Resources Director at:
michellep@habitatclallam.org or call: (360)775-3740.

This information will not be shared with anyone outside of Habitat Clallam’s Critical Home Repair Department.

Applicant Information

Do you have a co-applicant?

Co-Applicant Information

Contact Information

Repair Information

Gross Household Annual Income

Is anybody in your household an active member of the military?
Is anybody in your household a veteran?
Is anybody in your household disabled?

Residence Information

Do you have a mortgage?
Do you have homeowner's insurance?
Are your property taxes paid to date?
What type of home do you have?

Willingness to Partner

To be considered for the program, you and your household members must be willing to partner with our organization. Each adult in your household is considered a program participant who is required to complete program requirements. This includes applicants and any person over the age of 18 at the time of the application.

This is what is called "sweat equity". Each applicant must contribute 8 hours minimum.

Sweat equity does not necessarily mean construction-type work. It can be accomplished through admin or other volunteering opportunities.

Are you willing to partner? *

Information for Monitoring Purposes

Please read this statement before Completing the following questions:

The following information is requested by us to use in our reporting and for tracking purposes. You are not required to furnish this information but are encouraged to do so. The law provides that we do not discriminate on the basis of this information, nor on whether you choose to furnish it or not.

What is your gender?