Home Builders Foundation Application for Assistance
Application Acknowledgment REQUIRED
I acknowledge Home Builders only provides home modifications for accessibility in the 8-county Denver metro region: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Elbert, and Jefferson.  HBF is unable to provide modifications outside of our service area. We also do not provide home repairs, elevators, or walk-in tubs.



Please take your time with this form as it will be key in our ability to help you. 
Contact for the Application (Who Is Filling This Out)
Contact Address (If different from Applicant)
Scheduling Contact
Applicant Name (Who Are the Modifications For)
Format 01/01/1900
If your organization is not listed, please select “Other”
Applicant Home Address ( Project Location)
Landlord Contact Information
Home Owner's Association Contact
Household Financial Information
IMPORTANT: All financial information must be provided and complete. Thank you.

Brief Description of Circumstances

IMPORTANT: Please fill our this section thoroughly. This portion of the application is weighed in the decision to move forward in the approval process. Applications that do not satisfy this requirement may be denied.

Please summarize the health, disability, or situational circumstances causing the applicant’s physical disability and need for accessibility assistance from HBF inclusive of how long you have been in need.
Diagnoses

Description of Assistance Needed
Based on the description of circumstances listed above, describe the accessibility modifications you are seeking for your home. Please be aware HBF does not provide home repairs, elevators, or walk-in tubs. 



Anticipated Impact
Home Builders Foundation’s mission is to provide opportunities for individuals and families with disabilities to achieve a better quality of life and positively enrich their communities.

Please let us know how the home modifications you listed above will impact your independence and quality of life. What do you envision or hope to be able to do, that you are not able to do today, if these modifications are completed?

IMPORTANT: Please be as specific as possible. This portion of the application is weighed in the review process.

Attachments
Please include any attachments that you believe help describe your circumstances or needs.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx odt ppt pptx odp xls xlsx ods.
Terms of Acceptance and Signature
I have read the application and acknowledge that all statements given by me in this application are complete, accurate, and truthful to the best of my ability. Due to the nature of the application, I understand Home Builders Foundation (HBF) may share basic demographic, disability, and contact information provided on the application with HBF staff, board and committee members, volunteer crews, and any individual(s) associated with HBF and/or a HBF project. I consent to receive informational messages, appointment reminders, and support messages from HBF via SMS at the number provided. Msg & Data rates may apply. Msg frequency varies. Reply HELP for help or STOP to unsubscribe at any time. We do not share your phone number with third parties not directly associated with HBF or a HBF project.  Read our Privacy Policy & Terms and Conditions.
Yes

I also understand that HBF reserves the right to deny any request based on funds and resources available to HBF, location of project, and applicability to the HBF mission.
Yes
Send Response Email