Critical Home Repair Program Application

 

Our Critical Home Repair Program helps qualified homeowners in Box Elder and Weber Counties make important repairs to their homes, including critical fixes, weatherization, and updates to support aging in place.


Before applying for the Critical Home Repair Program, please review the following requirements:

Income Requirements

Review the chart above to see if you meet the required income guidelines.

Property Requirements

  • The home must be owner-occupied.

  • Habitat for Humanity Northern Utah cannot repair mobile homes.

  • The property will be inspected and must pass an environmental review.

  • Only permanent parts of the home are eligible for repair. 

Program Costs

  • When grant funding is available, homeowners are responsible for 25% of the total repair cost, which is financed through a 0% interest loan with affordable monthly payments.

How the Program Works

  1. Submit your application and upload all required documents.

  2. We will review your application and contact you with your application status or a request for additional information.

  3. If your application is conditionally approved, we will schedule a site assessment and develop a work plan for your repairs.

  4. Your application and work plan will be reviewed by a committee. Not all applications will be approved.

Submitting Your Application

To apply, complete the online application below and provide all required documents.
Upload documents securely by clicking here

Required Documents:

  • Verification of income (last 3 months) for all household members age 18+

  • Copy of current mortgage statement

  • Copy of current homeowner’s insurance certificate

  • Three months of most recent bank statements

  • Copy of photo ID

Or submit documents by mail or email:

Mail:
Habitat for Humanity Northern Utah
Attn: Dianne Nawyn
PO Box 456
Brigham City, UT 84302

Email:
habitat@hfhnu.com

Once your application is reviewed, you will be contacted regarding next steps. If approved, you will be required to sign legally binding program documents in person at our office:
111 East Forest Street, Suite A, Brigham City, UT

If you have any questions, please contact our office at 435-723-7133 or email habitat@hfhnu.com.

*Demographic information is used for reporting and ensuring equitable access to our process. Your response will not affect your eligibility for assistance.

 

 

Your Contact Information

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Electric Signature Disclosure

By submitting this application electronically, you agree to the use of electronic records and electronic signatures in connection with this application and any related documents.

You understand and agree that:

  • Your electronic signature is the legal equivalent of your handwritten signature.

  • Electronic records may be used instead of paper documents, and you may receive notices, disclosures, and other communications electronically.

  • You are responsible for providing a valid email address and keeping your contact information up to date.

  • You may request a paper copy of any document at no charge by contacting our office.

  • You may withdraw your consent to receive documents electronically at any time by notifying us in writing; however, withdrawal of consent may delay or prevent processing of your application.

By agreeing below, you confirm that you have read and understand this disclosure and consent to conduct business electronically.

The field I agree to these terms is required.
The field Social Security Number is required.
The field Disabled is required.
The field Race is required.
The field Employer is required.
The field Employer Address is required.
The phone field Work Phone Number is required.
The numeric field Years Employed here is required.
The numeric field Annual Income is required.
The field Other Income is required.

Co- Applicant Info

Complete this section only if you have a co-applicant applying with you

The maximum length for the field Co-Applicant Name is 500 characters.
The maximum length for the field Co-Applicant Address is 500 characters.
The maximum length for the field Co-Applicant City is 500 characters.
The field Co-Applicant Zip must be a number.
The maximum length for the field Co-Applicant Email is 500 characters.
The field Co-Applicant Phone must be a phone number.
The maximum length for the field Co-Applicant Social Security Number is 500 characters.
The field Co-Applicant Date of Birth must be a date.
The maximum length for the field Employer is 500 characters.
The maximum length for the field Employer Address is 500 characters.
The field Work Phone Number must be a phone number.
The field Years Employed here must be a number.
The field Annual Income must be a number.
The maximum length for the field Other Income is 500 characters.
The maximum length for the field Relationship to Applicant is 500 characters.

Additional Household Member age 18 or Older

List all additional household members age 18 or older who live in the home (for example: adult children, parents, or other relatives)

The maximum length for the field Full Name is 500 characters.
The maximum length for the field Social Security Number is 500 characters.
The field 1. Date of Birth must be a date.
The maximum length for the field Sex is 500 characters.
The maximum length for the field Employer is 500 characters.
The maximum length for the field Employer Address is 500 characters.
The field Work Phone Number must be a phone number.
The field Annual Income must be a number.
The maximum length for the field Full Name is 500 characters.
The maximum length for the field Social Security Number is 500 characters.
The field 1. Date of Birth must be a date.
The maximum length for the field Employer is 500 characters.
The maximum length for the field Employer Address is 500 characters.
The field Work Phone Number must be a phone number.
The field Annual Income must be a number.

Children living in the home under the age of 18

Include all children living in the home under age 18, whether biological or non-biological.

The maximum length for the field Full Name is 500 characters.
The field 1. Date of Birth must be a date.
The maximum length for the field Full Name is 500 characters.
The field 1. Date of Birth must be a date.
The maximum length for the field Full Name is 500 characters.
The field 1. Date of Birth must be a date.
The maximum length for the field Full Name is 500 characters.
The field 1. Date of Birth must be a date.

Homeownership and Property Information

Homes must have a permanent foundation to be eligible for repair services. Due to program policy, Habitat for Humanity of Northern Utah cannot provide repairs for mobile homes or homes without a permanent foundation.

The field Is your home on a permanent foundation? is required.
The field Do you own your home? is required.
The numeric field What is the balance owning on your home? is required.
The numeric field How much is your monthly payment? is required.
The field How long have you owned this property? is required.
The field Who is your property insurance company? is required.
The numeric field What is the approximate value of your home? is required.
The field Do you have any liens on your property? is required.
The maximum length for the field If yes, please explain: is 500 characters.
The maximum length for the field Additional names on title is 500 characters.
The field Do you own property besides your home? is required.
The maximum length for the field If yes, please explain. is 500 characters.

Monthly Debt Obligations

The field Do you have any car loans/leases? is required.
The maximum length for the field If yes, how much? is 500 characters.
The field Do you make monthly credit card payments? is required.
The field If yes how much? must be a number.
The field Monthly payment amount: must be a number.

Credit History Information

The field Do you have a large amount of credit debit? is required.
The maximum length for the field If yes, how much? is 500 characters.
The field Credit history issues (bankruptcy, collections)? is required.

Home Repair Needs

Please note: Items listed will be considered for repair; however, final decisions on what work can be completed will be made at the discretion of Habitat for Humanity of Northern Utah based on available time and financial resources.

The field Description of Needed Repairs is required.
The maximum length for the field Anything else we should know? is 5000 characters.

How did you hear about us?

The maximum length for the field How did you hear about the repair program? is 500 characters.

Applicant Agreement and Program Acknowledgment

Privacy Notice 

The information you provide in this application, including any documents uploaded, emailed, or mailed, will be used only to determine eligibility and to administer Habitat for Humanity Northern Utah’s Critical Home Repair Program. Your information will be kept confidential and securely stored. It may be shared only with program partners, contractors, or funding agencies as required for program administration, reporting, and compliance. We do not sell or use your information for marketing purposes.

 

By submitting this application, I acknowledge and agree that:

Truthfulness of Information

I certify that all information provided is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in denial, removal from the program, and/or repayment of any assistance received.

Program Understanding

I understand that submission of this application does not guarantee approval. If approved, I agree to follow all Habitat for Humanity Northern Utah policies and procedures.

Required Documentation

I understand that my application will not be considered complete until I submit the required documents through the application link, by email, or by mail, including:

  • Income verification for all household members age 18 and older (last 2 months)

  • Most recent mortgage statement

  • Current homeowner’s insurance certificate

  • Three months of recent bank statements

  • Copy of a valid photo ID

Authorization

I authorize Habitat for Humanity Northern Utah and its representatives to verify all information provided, including income, credit history, property ownership, and title status.

Loan Agreement (If Applicable)

If approved, I agree to sign all required loan documents, which may include a Trust Deed and Trust Deed Note.

Communication Requirement

If approved, I will receive formal notification and must respond within two (2) weeks. Failure to respond may result in the need to reapply.

Program Responsibilities

If selected for the program, I agree to:

  • Cooperate with Habitat staff and contractors throughout the project

  • Allow reasonable access to the home and utilities as needed

  • Sign all required project documents, including contracts and completion forms

  • Pay for title and credit reports if the loan does not proceed

Acknowledgment of Risk

I understand that any repairs completed prior to receiving a written commitment from Habitat are done at my own risk and expense.

Media & Participation Consent

I understand that Habitat may partner with sponsors and volunteers and may share limited information about my project for promotional purposes, including in newsletters, on its website, and on social media. This may include photos, interviews, and participation in community events.

Acknowledgment

By submitting this application, I confirm that I have read, understand, and agree to the terms outlined above.

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