Greater Bordeaux Homeowner Interest Form
Fill this form out ONLY if you live in the communities of Greater Bordeaux in Nashville.

Please fill out every field below completely.  If you don’t know the answer write “unknown”. If the question doesn’t apply to you, write “N/A”.

This is not an application for services, but decisions for application availability in Greater Bordeaux beginning in 2020 will be based on Interest Form responses. If Rebuilding Together determines that you might meet our qualifications, you may be invited to fill out a full application.

You do not need to turn in any documents with this form.  
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Homeowner first name *
Homeowner last name *
Homeowner date of birth *
Property Address (example: 123 Main St. Nashville, TN 37200) *
Best Phone Number *
Email address *
Are you or another household member a veteran of the United States Armed Forces? *
Do you or another household member receive Disability Benefits? *
Number of children (17 years or younger) in home *
Number of adults in home (including homeowner) *
List all income in the household and who receives it.  Include Social Security, retirement benefits, wages, etc. (example: $1,234 in Social Security for Jane Jones and $350 weekly in wages for Sara Jones) *
Do you currently live in the home? *
Are your property taxes paid in full? *
Do you have a current homeowner insurance policy?  If yes, write the name of the company and the date your policy will expire. *
Do you have a monthly mortgage payment?  If yes, how much is it each month? *
Do you have a reverse mortgage or home equity loan? These will not disqualify you. *
How much is your average utility bill in a normal month (combine electric and gas if applicable)? *
How much is your average utility bill in the winter months (combine electric and gas if applicable)? *
Please check which item(s) in your home need repair(s) *
Good Condition
Needs repair(s)
Heating/Air Conditioning (HVAC) system
Gutters and Downspouts
Exterior doors, porches and/or steps
Walls (exterior or interior)
Water heater
Electrical system
Stove or refigerator
Sinks, tubs, and/or toilets
Foundation, crawlspace and/or basement
Please provide details about any item marked "needs repair" above *
Do you have old carpet in your home? *
Is it easy to get in and out of your tub/shower and to get on and up from the toilet? *
Please tell us the top three home improvements you hope Rebuilding Together can help you complete. *
Which of the following community spaces do you visit monthly or more often? (check all that apply)
What are the biggest strengths of the Greater Bordeaux community, and what are its biggest challenges?
Rebuilding Together may offer classes in the community. Which of the following classes might interest you? (check all that apply)
Is there any additional information you wish to share?
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