Home Repair Inquiry Form
Thank you for your interest in applying to Austin Habitat for Humanity's Home Repair Program. Our Critical Repair Program is here to help low income homeowners receive the necessary repairs to make their houses safe, livable, and free form hazards. Due to the high volume of inquiries we receive for assistance, we currently have a waitlist to apply for assistance from our program. At this time, we are only able to assist homeowners in the counties of Travis, Bastrop, Caldwell, and Hays who reside in single-family detached residences, and manufactured homes that are permanently affixed to real property that is owned by the homeowner. We are NOT able to complete repairs on rentals, condos, townhomes, or duplexes. The homeowner MUST reside in the home to be eligible.

Please complete the form below if you wish to be added to our waitlist.

PLEASE NOTE THIS IS NOT AN APPLICATION FOR SERVICES.

Property Information
Homeowner(s) Name(s) *
Your answer
Address of property in need of repair (include address, city, zip code): *
Your answer
Homeowner's Contact Information
Phone # *
Your answer
Email Address:
Your answer
Alternate Contact Information
If you are assisting someone with this application process, or you would like for us to contact someone else on your behalf who is assisting you, please fill out the section below.
Contact Name:
Your answer
Phone #
Your answer
Email Address:
Your answer
Household Demographic Information
This information is gathered only for demographic reporting and grant funding purposes. Please note this information is NOT used to determine eligibility.
# of individuals living in the house: *
Your answer
Is anyone in the household over 60?
Is anyone in the household physically or mentally disabled?
Is anyone in the household a veteran?
Is the homeowner the surviving spouse of a veteran, who was married to the veteran during the veteran's active duty?
Repair Needs
Please include a brief description of the repairs needed:
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.