Eligibility Assessment Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Program funded by:

Welcome to the Cornerstones of Community Owner-Occupied Repair Program!

Thank you for your interest in the Cornerstones of Community Owner-Occupied Repair Program. Our goal is to help long-term residents stay safely and comfortably in their homes by providing significant home repairs at no cost to eligible homeowners. This short prescreen will help us confirm whether you meet the basic requirements before moving forward.

Basic Eligibility Criteria

To qualify, applicants must:

Own their home and be listed on the property’s deed (no land contracts).
Live in the home as their primary residence.
Meet income guidelines based on household size (see Income Limits Summary table below).
Have repairs that fall within our program’s scope (health, safety, accessibility, and essential systems).
Be located within the program’s service area (generally, 46218, 46219, 46226, 46229, 46235 - see map for specific boundaries).

If you meet these criteria, please continue with the intake form. If you’re not sure, we still encourage you to apply - our team will review your information and follow up with next steps.

In addition, feel free to review our FAQ.

Income Limits Summary

First Name *

Last Name *

Phone *

Address Line 1 *

Address Line 2

City *

State *

ZIP *

Are you the owner of the property at this address? *

Yes

Is this your primary residence? *

Yes

Estimated Annual Household Income *

Persons in Household *

Please briefly describe your home repair need. *

How did you hear about us? *

Online Search

Friend or Neighbor

Mail

Door hanger

Door to door canvassing

Eastern Star Church

Living Word Baptist Church

Edna Martin Christian Center

Mt Paran Baptist Church (Hope CDC)

New Direction Church

CAFE Indy - Community Alliance of the Far Eastside

Indy.gov Referral

Other

Required

Funding for home repairs is often contingent on specific eligibility criteria, program availability, and budgetary constraints, and therefore cannot be guaranteed. *

I acknowledge that funding for home repairs is often contingent on specific eligibility criteria, program availability, and budgetary constraints, and therefore cannot be guaranteed.

I DO NOT acknowledge that funding for home repairs is often contingent on specific eligibility criteria, program availability, and budgetary constraints, and therefore cannot be guaranteed.

Communication Consent & Messaging Authorization

Communication Consent

By submitting this application, I voluntarily provide my phone number(s), email address(es), and other contact information and consent to be contacted by the Cornerstones of Community Owner Occupied Repair Program and its administrators, partners, contractors, and service providers for purposes related to my application, eligibility determination, repair coordination, scheduling, follow-up, program updates, and required legal or administrative communications.

Methods of Communication

I understand and agree that communications may be sent via:

Phone calls (including live calls and voicemails)
Text messages (SMS or MMS)
Email
Other electronic or written communication methods as necessary to administer the program

Message frequency may vary based on program activity and repair needs.

Information Collected and Used

I acknowledge that communications may include the collection and use of:

My name, address, phone number, and email address
Information related to my home, repair needs, eligibility, scheduling, and participation
Message content, timestamps, and limited technical data (e.g., carrier information) necessary for program operations

This information will be used solely for administering the repair program, improving service delivery, meeting legal or funding requirements, and maintaining accurate program records.

Text Message Consent & TCPA Disclosure

If I provide a mobile phone number, I expressly consent to receive non-marketing text messages related to the repair program. I understand that:

Consent is not a condition of receiving services, except where communication is necessary to coordinate repairs or comply with legal requirements
Standard message and data rates may apply
Text messages may be sent using third-party messaging platforms

Opt-Out & Revocation of Consent

I may opt out of receiving text messages at any time by replying “STOP” to any text message.
I may opt out of email communications by using the unsubscribe link provided in emails.

I understand that opting out of certain communications may impact program eligibility, limit the program’s ability to coordinate repairs, or may require communication by alternate methods, and that some communications may still be required by law or program administration.

Data Sharing & Retention

I understand that my information:

Will not be sold or shared for marketing purposes
May be shared with trusted third-party service providers (e.g., contractors, inspectors, messaging platforms) only as necessary to administer the program
Will be retained in accordance with applicable laws, funding requirements, and record-retention policies

Acknowledgment

By signing or submitting this application, I acknowledge that I have read and understand this Communication Consent & Messaging Authorization and agree to its terms.

I AGREE to the Communication Consent & Messaging Authorization.

I DO NOT agree to the Communication Consent & Messaging Authorization.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Englewood Community Development Corporation.

Does this form look suspicious? Report

Forms