A Brush With Kindness Home Repair Program

A Brush with Kindness helps low-income homeowners impacted by age, disability and family circumstances, who struggle to maintain the exterior of their homes. We partner with these families with exterior repairs, yard clean-up, exterior painting, and light landscaping to help them reclaim their homes with strength and dignity.

2025 Household Size/Income Requirements (Maximum Amount)

Clark County

Household of 1: $43,020

Household of 2: $49,200

Household of 3: $55,320

Household of 4: $61,440

Household of 5: $66,360

Household of 6: $71,280

Household of 7: $76,200

Household of 8: $81,120

Household Size/Income Requirements (Maximum Amount)

Madison County

Household of 1: $37,140

Household of 2: $42,480

Household of 3: $47,760

Household of 4: $53,040

Household of 5: $57,300

Household of 6: $61,560

Household of 7: $65,820

Household of 8: $70,020

Your Contact Information

First Name *

Last Name *

Email *

Gender

Marital Status

Date of Birth *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Emergency Contact *

Emergency Contact Phone

Emergency Contact Email

Co-Applicant Information

If there is another name on the mortgage other than the applicant, please fill out information below.

Co-Applicant's Name The maximum length for the field Co-Applicant's Name is 500 characters.

Date of Birth The field Date of Birth must be a date.

Phone Number The field Phone Number must be a phone number.

Email Address The field Email Address must be an email.

Demographic Information

PLEASE READ THIS STATEMENT BEFORE COMPLETING THE BOX BELOW

The purpose of collecting this information is to help ensure that all the applicants are being treated fairly, that the housing needs of communities and neighborhoods are being fulfilled, and to otherwise evaluate our programs and report to our funders. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, sex and race) in order to monitor our compliance with equal opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information but are encouraged to do so. The law providers that we may not discriminate on the basis of this information or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, federal regulations require us to note your ethnicity, sex and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application.

Applicant's Ethnicity

Applicant's Race

Applicant's Gender

Co-Applicant's Ethnicity

Co-Applicant's Race

Co-Applicant's Gender

Property Information

Present Address The maximum length for the field Present Address is 500 characters.

Number of Years at Address The field Number of Years at Address must be a number.

Year the home was build? The maximum length for the field Year the home was build? is 500 characters.

Type of Home

What year did you move into your home The field What year did you move into your home must be a number.

Do you own this home?

Is there a Homeowner's Association?

Are the property taxes current?

Are there any current citation/code violations?

Do you have homeowner's insurance?

Who is your insurance provider? The maximum length for the field Who is your insurance provider? is 500 characters.

What is your policy number? The maximum length for the field What is your policy number? is 500 characters.

Are you current on your mortgage payments?

Is the home paid off?

Repairs Requested

Check the type(s) of work you would like done on your home. Remember that the items listed below will be considered for repair, but the final decision on what work can be done with our time and financial resources will be made at the discretion of HFHMCC. Our volunteers are not professionals and may not be able to make all repairs. Please keep in mind that the ABWK Program focuses on minor exterior repairs listed below.

Type of Repairs Requested

Provide Details of Repairs Requested The maximum length for the field Provide Details of Repairs Requested is 5000 characters.

Other Household Members

Please list all other household members other than Applicant/Co-Applicant.

1. Name The maximum length for the field 1. Name is 500 characters.

Date of Birth The field Date of Birth must be a date.

Age The field Age must be a number.

Gender

Relationship to Homeowner The maximum length for the field Relationship to Homeowner is 500 characters.

2. Name The maximum length for the field 2. Name is 500 characters.

2. Date of Birth The field 2. Date of Birth must be a date.

2. Age The field 2. Age must be a phone number.

2. Gender

2. Relationship to Homeowner The maximum length for the field 2. Relationship to Homeowner is 500 characters.

3. Name The maximum length for the field 3. Name is 500 characters.

3. Date of Birth The field 3. Date of Birth must be a date.

3. Age The field 3. Age must be a number.

3. Gender

3. Relationship to Homeowner The maximum length for the field 3. Relationship to Homeowner is 500 characters.

4. Name The maximum length for the field 4. Name is 500 characters.

4. Date of Birth The field 4. Date of Birth must be a date.

4. Age The maximum length for the field 4. Age is 500 characters.

4. Gender

4. Relationship to Homeowner The maximum length for the field 4. Relationship to Homeowner is 500 characters.

Household Income Information

Monthly Income of Applicant The field Monthly Income of Applicant must be a number.

Source of Income

Monthly Income of Co-Applicant The field Monthly Income of Co-Applicant must be a number.

Source of Income?

Monthly Income of Adults Living in Household The field Monthly Income of Adults Living in Household must be a number.

Income Source

Declarations

Are you and all adults in your household legal U.S. Citizens?

Are you currently involved in a lawsuit related to your property?

Do you agree to continue to maintain the home to the best of their ability (keep neat, clean, and in good repair) so as not to reduce its value or that of the neighborhood?

Is any household member active U.S. Military?

Is any household member a veteran?

Personal Statement

Please write a brief explanation of why you feel you should be selected for assistance under Habitat for Humanity of Madison and Clark Counties' A Brush With Kindness or Rock the Block program and how it will help you. The maximum length for the field Please write a brief explanation of why you feel you should be selected for assistance under Habitat for Humanity of Madison and Clark Counties' A Brush With Kindness or Rock the Block program and how it will help you. is 5000 characters.

Electronic Signature

Electronic Signature Authorization
By typing my name below, I acknowledge that this action constitutes my electronic signature. I understand that this electronic signature is legally binding and has the same validity as my handwritten signature.

Authorization, Agreement and Release

I certify that the information on this application is accurate and that I own the property at the given address.

I certify that verification may be obtained from any source named in this application.

I understand that this application can be rejected at any time if information provided is incorrect or untrue.

I further declare that I have no intention to move, sell, or rent this residence for at least three years.

I authorize Habitat for Humanity of Madison and Clark Counties (HFHMCC) to examine my income, residency, and any other requirements throughout the application process.

I understand that HFHMCC will make the final decision regarding the work that can be done at my home and that I will receive a Homeowner Agreement with a scope of work before any repairs are made to my home.

Additionally, I certify that no members of our household are currently or will be involved in the future in any type of illegal activity and I authorize Habitat for Humanity of Madison and Clark Counties to investigate my criminal history if necessary.

I also understand that Habitat for Humanity screens all applicants and adults (18 years and up) in their household on the sex offender registry. By completing this application, I am submitting myself to such an inquiry.

As an applicant, I acknowledge Habitat for Humanity of Madison and Clark Counties has obtained non-public and public information for the application to be processed and that they will keep this information in a secure place and it will not be shared with any unauthorized parties.

I further understand that the people who may work on my house are unpaid volunteers and that few, if any of them, are skilled in the building trades. I understand that Habitat’s A Brush with Kindness and Rock the Block programs make no warranties, expressed or implied, regarding any materials used or work done by any of the volunteers throughout this project.

I hereby agree that I will not make a claim against or sue Habitat for Humanity of Madison and Clark Counties and any of our affiliates for injury or damage resulting from negligence or other acts caused by any employee, contractor, or participant in the A Brush with Kindness or Rock the Block activities.

I hereby release Habitat for Humanity of Madison and Clark Counties and any of its affiliated organizations from all actions, claims or demands that I now have or may hereafter have for injury or damages resulting from my participation in the A Brush with Kindness or Rock the Block project(s).

Applicant's Signature * The field Applicant's Signature is required.

Date * The date field Date is required.

Co-Applicant's Signature * The field Co-Applicant's Signature is required.

Today's Date * The date field Today's Date is required.