Apply for Repairs

Please complete each of the steps below to apply for home repairs.

  1. Find out if you qualify.
    Read our qualifying criteria.

  2. Fill our our application.
    Fill out the online form below. 
    OR
    Click here for a printable application.
     
  3. Provide proof of all household income.
    Email Proof of Income documents to: cindy@rebuildingtogetheraustin.org
    Or mail to: Rebuilding Together Austin | P.O. Box 6939 | Austin, TX 78762

Proof of All Household Income
If you are currently receiving AFDC, SSI, VA or GA, submit proof of income or a printout from that month (Ex: Social Security Award Letter, Wages (check stubs to show 2 months of pay), Pension award letter).

Online Form

Contact Name *
Contact Name
Address *
Address
Are You a Veteran? *
Name, Age, Relationship, Employed (Yes/No)
Name, Age, Relationship, Employed (Yes/No)
Name, Age, Relationship, Employed (Yes/No)
Name, Age, Relationship, Employed (Yes/No)
List all below. Name, Age, Relationship, Employed (Yes/No)
Include income from all household members.
$
Are you currently employed? *
$
$
List sources and amounts.
$
$
$
Do you own real estate other than your primary residence? *
Will you and/or family and friends be able to help volunteers accomplish the repairs on the workday? *
We expect the homeowner and/or family and friends to help.
What are the four most important repairs needed at your home?
Can you get in and out of the tub/shower with ease? *
Is it difficult to see to get to the bathroom at night? *
Is it difficult to get on and off the toilet? *
Do you have strips in the bath/shower that keep you from slipping? *
Do you have smoke/fire detectors in your home? *
Emergency Contact *
Emergency Contact