Hearts & Hammers Application 2018
Refer a Home, Request Help

If you would like your home or someone else's home considered for Hearts & Hammers repairs on the May 5th, 2018 workday, please fill out this form completely, using the curser on the right to navigate to the bottom of the page if necessary. If you are filling out this form for someone else, please have their permission to do so.
If You Need Immediate Help, there are a number of volunteers who are willing to give help throughout the year for those homeowners with emergency needs that cannot wait for the May workday.
Contact: Home Emergency Action Repair Team (HEART)

Phone: 360 221-6063

Contact Name *
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Contact email *
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Contact Phone *
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Best time to call
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I am making this request for: *
Required
Resident / Owner's Name (reenter if same as contact) *
Your answer
Project Street Address *
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City *
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Zip *
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Is the House # easily visible from the street? If not, please give directions.
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Date of this Request *
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Does the resident own this home? *
How long has the resident been here?
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How long do you plan to stay?
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Number of people in household
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Ages of people in household
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Monthly Household Income
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Last year's household income
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Major expenses
Let us know your major expenses such as mortgage and medical expenses; please specifiy
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Any disabilities or other personal information you want us to consider:
Who is disabled? What are the issues?
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What parts of the site has problems? *
Required
What Repair or Problems can we help you with? Please describe want you think needs to be done. *
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Building Construction *
Required
Year of Construction (best estimate) *
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Has Hearts and Hammers worked on this home? When & What was done?
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Any other information & issues we should know?
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Do you need firewood? How much?
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