Project Repair / Tool Loan Application

Program(s) Desired *

Repair Workshops (open to all)Tool Loan (CH residents only - note income guidelines)

First name *

Last name *

Address *

AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountry

Other adults in household to join (if applicable)

Spouse/partner first name

Spouse/partner last name

Other first name 1

Other last name 1

Other first name 2

Other last name 2

At least one phone number is required.

Home phone

Cell phone

Work phone

If no email address, enter "none"

Email address *

Nuts & Bolts newsletter *

Email (free)Pick up or read on website (free)Mail hard copy ($5/year)

Status of ownership *

OwnRent

Unit type *

Single-familyMulti-family

Agreement *

I certify that the information on this form is accurate and complete. I understand that Section 1001 of Title 18 of the US Code makes it a criminal offense to make false statements or misrepresentations to any Department or Agency of the U.S as to matters within its jurisdiction.

fostering diverse &
sustainable neighborhoods
through well-maintained homes

Project Repair / Tool Loan Application

Household information (for HUD funding of PR programs)

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