Application For Home Repair Services

Please provide the name, income level, and source of income for ALL household members who are 16 years of age and up. If additional space is needed, please use the notes section below and follow the same format for each additional applicant.

*Updated 4/1/20

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Income *

Source *

Applicants are required to verify income for each person (16 years and older) either by mail or email. Acceptable forms of “Proof of Income” include:

Copies of last 3 consecutive months of pay stubs, wages, and salaries before deductions
Self-Employment-most recent tax return and/or self-declaration of weekly/monthly income signed and dated
Social Security, Supplemental Security Income (SSI), Social Security Disability Income (SDI). You can request a copy by calling 1-800-772-1213
SNAP/TANIF/ADC
Veterans benefits
Retirement/Pension/Annuities
Unemployment/Workman’s Comp
No Income: A Certification of Zero Income form can be requested by contacting the Red Feather office

Reciprocity and Project Contribution
Applicants requesting help under our Native Home Resource Network that are willing to have an active role in their project may be given a higher priority in receiving assistance from Red Feather. Since our work is provided to the homeowner for free we see this as a way of showing appreciation for the services that are provided. Of course, exception to this are made for those who don not have the ability to contribute to their project.

Please check those that you may be able to help with or provide a written description of another not listed: *

Contributing labor with construction skills to your project Contributing building materials to your project Hosting a volunteer or group interested in learning more about your community Tell us a personal story we can share with our supporters Donating art for raffle or a gift to donors Providing meals for volunteers working on-site on your project Staying engaged in your project: completing all paperwork, returning phone calls, tracking down potential leads such as meeting with local services providers on request

Supporting documents can be Sent via mail or email to the following:

Mailing Address:
Red Feather Development Group
2501 N. 4th Street
Flagstaff, AZ 86004

Email:
shannon@redfeather.org

certification_of_zero_income_1.21.19.pdf
File Size:	222 kb
File Type:	pdf

home_owner_rental_authorization_form.pdf
File Size:	202 kb
File Type:	pdf

nhrn_wx_usda_combined_application_1.29.20.pdf
File Size:	487 kb
File Type:	pdf

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