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Connective            



2025 Habitat for Humanity Home Repair Form

Please do not fill out this form more than once. If you have questions about an existing application, please email info@connectivetx.org with your name and address.
Important Information

Thanks for your interest in Houston Habitat for Humanity's Home Repair program.


Please note that the successful submission of your application is not a guarantee of home repair assistance, and you may be asked to provide additional information at a later date.


Due to limited funding, Houston Habitat for Humanity will be prioritizing critical life and safety repairs, including roof damage, mold remediation, and other hazardous conditions.

Document Uploads

Before You Begin

To help you complete this application efficiently, please have the following documents ready to upload:

Proof of Income Documentation (as applicable to your situation):

  • Public benefits documents (SNAP, Medicaid, etc.)
  • Recent wage/pay stubs
  • W-2 forms
  • Self-employment income records
  • Retirement or pension income statements
  • Social Security income documentation

Having these documents prepared in advance will make the application process quicker and smoother. We accept many document formats including PDFs, JPGs, PNGs, and more.


Need Help? If you need assistance uploading documents, please visit us at: Houston Habitat for Humanity 3750 N McCarty St Houston, TX 77029


For other questions about which documents apply to your situation, please contact us at info@connectivetx.org or (713) 903-7819.

Please enter the address of the home that needs to be repaired.

Please type your street address and city, and then click on the matching result. Please do not include apartment numbers or unit numbers.













Page 2

If you need assistance filling out this application over the phone, please call (713) 903-7564
 to speak with a representative in English or Spanish.
Primary Household Member Information




We strongly encourage you to provide your email address or that of a trusted friend or family member in order to receive the most up to date information on the status of your application.







Demographics







Page 3

If you need assistance filling out this application over the phone, please call (713) 903-7564
 to speak with a representative in English or Spanish.






Household Demographics

Household Characteristics



Dwelling Information




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Home Repairs Needed
Please select all home repairs that are needed:



Why are these repairs important to the homeowner?






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Military Service and Veteran Details










Here are services available in our area for Veterans:

Military Service and Veteran Details Section
The following document uploads are required for the Texas Veterans Commission Grant



Examples:
One document issued by the U.S. Department of Defense (DOD): Uniformed Services Identification (USID) Card listing Veteran Spouse as Sponsor
Or (Both) Documents from County Clerk
Marriage Certificate or Registered Common Law Marriage Declaration
Death Certificate

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If you need assistance filling out this application over the phone, please call (713) 903-7564
 to speak with a representative in English or Spanish.
Income Eligibility Information




$
per month
Please enter numbers only and round to the nearest dollar. Commas, decimals, and special characters (such as $) are not allowed.


















Note: If you submit the application without submitting the required documents, Connective will follow up with you to submit them at a later time. The application will not be considered complete until we receive the documents.
Proof of No Income
Acceptable documents are documents demonstrating no income:

Proof of Salary/Wages
Acceptable documents are documents demonstrating income:
  • 2023 signed tax return listing all adult household members
  • 2023 W2(s) for every job held by each adult household member
  • Unemployment compensation statement showing 2023 income
  • Paystubs for the last 30 days
  • Letter from employer verifying monthly salary/wages

Proof of Self-Employment Income
Please complete the following Profit and Loss Ledger and upload it below. If you have your own, you can also submit it below.

Proof of Unemployment Income
Acceptable documents are documents demonstrating unemployment income:
  • Current TWC unemployment check
  • Unemployment compensation statement
  • Letter from employer of termination from employment

Proof of Retirement and/or Pension Income

Proof of Social Security Income

Proof of SSI/Disability Income

Proof of Alimony and/or Child Support Income

Proof of Other Income
If you do not have a document that records your income, please complete the following Declaration of Income Statement and upload it below.

Waiver


You must acknowledge the above statement and authorize Connective to share your information with other organizations in order to submit this form. 

Are you interested in receiving text notifications about local, free resources and services in our area?
Connective Texts is a free service that sends subscribers 2–3 texts with local resources per week. 

Disclosures:
  • You will receive up to 10 text messages/month from Connective related to nonprofit and government resources.
  • You confirm that you are the subscriber to the relevant phone number or that you are the customary user of that number on a family or business plan and that you are authorized to Opt In.
  • Message & data rates may apply.
  • You can opt-out at any time by replying “STOP” to the text messages you receive.
  • You can adjust my subscription settings by replying "HELP" to the text messages you receive.
  • You will be texted a reminder of instructions for opting out of text messages at least once a month.
  • Your phone number will not be shared with any other organization without your explicit consent.