Safe & Healthy Home Improvement Program Initial Screening Form
Eligible homeowners interested in RTN’s Safe & Healthy Home Improvement Program (SHHIP) must complete this initial screening form.

Instructions:
Please fill out every field completely. This is not a full application for services. The information you provide will help determine whether you qualify to receive the full application. A list of eligibility requirements can be found here.

Rebuilding Together is currently working in the Greater Bordeaux community and the Dickerson Pike Corridor community. Fill this form out ONLY if you live in either the Greater Bordeaux or the Dickerson Pike Corridor.   

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Program Info
What community do you live in? *
SHIPP Repair Options:
Critical Repairs: Critical repairs can include various improvements and the scope of work varies greatly from home to home depending on funding availability and household needs. Homeowners will agree to sign a five-year, forgivable lien on the property for the full value of completed home improvements.  
The process from application to project completion generally takes between six (6) and 12 months.

Rapid Repairs:
Rapid repairs are repairs that are valued under $5,000 and can include: fixing water leaks/plumbing issues, electrical issues, gutter repair/replacement, replacing damaged doors, installing grab bars, electrical repairs, repairing a leaking roof, replacing faulty appliances, hot water heaters, and other issues that could lead to larger repairs in the future. 
The process from application to project completion generally takes between three (3) to four (4) months.

Homeowners can specify which option they are interested in, but Rebuilding Together Nashville will make the determination after reviewing home improvement needs.

What SHHIP option are you interested in applying for? *
Household Residents & Income
Homeowner first name *
Homeowner last name *
Homeowner date of birth *
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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 Gross 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).  This is the pre-tax amount. Does not apply to full time students. *
Property Information
Do you currently live in the home? *
Are your property taxes paid in full? *
Do you have a current homeowner insurance policy?  *
Do you have a monthly mortgage payment?   *
Do you have a reverse mortgage or home equity loan? These will not disqualify you. *
If YES to either above, have you made all payments due for the last 12 months?   
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Please tell us the top three home improvements you hope Rebuilding Together can help you complete. *
Is there any additional information you wish to share?
If your added to the application waitlist, how would you prefer to receive an application?
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Next Steps:

When your form is received and if it is determined you qualify through the initial screening, you will be added to our list of homeowners to receive an application. RTN's construction team will reach out to conduct a phone screening to determine which project option, Critical or Rapid, is the best fit for your home improvements needs.

 We work in on a limited number of projects at a time.  We will mail you a full application when we are getting ready to start new projects.

 The full application is a more comprehensive form and you will be asked to provide documentation supporting the eligibility requirements when you submit an application.
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