Repair Voucher Application
Thank you for applying for a voucher with our Pilot Repair Voucher Program!!

Note: Filling out an application for a voucher does not mean you will receive a voucher. Folks will be selected based on our program values, then randomly to be a part of our initial run of vouchers. Below you will find information about why the program exists, how it works, and what it is.

Why the Pilot Repair Voucher Program exists (Program Values):

The purpose of the this test voucher program is to:
*Spread repair culture
*Reduce the financial barriers to repairing belongings
*Prioritize communities of color and queer communities
*Grow the repair economy in Portland

How the Pilot Repair Voucher Program works:

*Initially, Repair PDX is partnering with two repair businesses: JD’s Shoe Repair and Hidden Opulence.
*For each business, there will be 50 vouchers available for the amount of $40 towards the cost of the repair.
*Only one voucher may be used for a single repair and if the cost of the repair is greater than $40, the customer is required to pay the difference
*Folks will be selected using criteria from the purpose statements, and selected randomly to receive a voucher.

What the Pilot Repair Voucher Program is:

Through a generous grant by the Oregon Department of Environmental Quality, we are able to begin a Pilot Repair Voucher Program. Together with community partners and repair businesses, Repair PDX will begin testing out offering repair vouchers in 2022 on a limited basis.

Instructions on how to apply for the Pilot Repair Voucher Program:

*Fill out the voucher application
*If selected, you will be sent an email with an electronic voucher
*Instructions on how to use the voucher will be sent to you as well. Depending on the type of voucher, either bring it into the shop or fill out an online repair request.

Sign in to Google to save your progress. Learn more
Email *
Name (First and Last) *
Mailing Address *
City *
Zip Code *
Are you interested in Shoe/bag/purse Repair or Mending Voucher?
What gender do you identify with? (ok to write NA if prefer not to answer) *
What ethnicity(s) do you identify with? (ok to write NA if prefer not to answer) *
What is your age? *
What is your yearly income? *
How did you find out about the Repair Voucher Program? *
Is this your first time working with Hidden Opulence? (Please skip if not interested in mending)
Clear selection
In a numbered list, please give a short description of each item along with the type of alteration or repair desired. *
Are you able to send photos? *
What is your level of need to get your clothing items repaired? *
Is this your first time working with JD's Shoe Repair?
Clear selection
Have you ever gotten shoes, purses, or bags repaired at JD's Shoe Repair shop before?
What item needs repair? *
What's broken/needs fixing? *
What, if any, parts are needed? *
What is your level of need to get your shoes/bags/purses/etc repaired?
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy