Rebuilding Together of South AL Homeowner Application
This is an application for services by RTSA. Primary households located in Choctaw, Clarke, Mobile, and Washington counties in Alabama are eligible. Please keep a copy for your records. You will be contacted when resources are available to offer support in your area. Proof of income for every resident in the household is required for processing. For further questions, send an email to twalker@rebuildingtogethersa.org 

Eligibility Requirements
*You must own your home, and you must have lived in it for three years.
*You must own a home in Choctaw, Clarke, Mobile, or Washington counties in Alabama.
*You must intend to remain in your home for at least five years.
*The total gross income for all residents of your home must be less than the amount shown below to meet Rebuilding Together's income guidelines.

Low-Income Limit (LIL) 80% of Median*

1 Person-$43,650

2 Person-$49,900

3 Person-$56,100

4 Person-$62,350

5 Person-$67,350

6 Person-$72, 350

7 Person-$77,350

8 Person-$82,300

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Email *
Income Requirements and Application Process-Proof of Income Required

Please note that ALL household members, including roommates and extended family members, must provide accurate income information for Rebuilding Together to process an application. Applicant households with an annual income of up to 80% of HUD's area median income are eligible. Applicant households with an annual income of up to 80% of HUD's area median income will be prioritized. HUD's area median income guidelines are calculated annually. Most recent guidelines are included below. HUD posts current guidelines at https://www.huduser.gov/portal/ datasetslil.html 

Application Process: 

•Complete the homeowner application 

•Collect proof of income for EACH resident of the home and email income to twalker@rebuildingtogethersa.org after submission of this application.

• Supporting documents should be emailed to twalker@rebuildingtogethersa.org or mail the proof of income to: Rebuilding Together of South Alabama, P.O. Box 1752, Mobile, AL 36633 Please email with any questions regarding the application at twalker@rebuildingtogethersa.org 


Household Size *
Annual Household Income *
Homeowner 1 Name *
Homeowner 1 Age *
Homeowner 1 Gender *
Homeowner 2 Name if applicable
Homeowner 2 Age if applicable
Homeowner 2 Gender if applicable
Client's Preferred Phone Number *
Residential Address *
Mailing Address- if Different
Email address *
Which County does the client reside? *
What type of structure is your primary home? *
Type of Support Request *
Required
Household Information
Rebuilding Together uses this information for annual reports to federal agencies providing funding or repairs, and to apply for certain grants. Rebuilding Together does not share specific gender, disability, race and ethnicity or other personal information with outside agencies. The data you choose to provide here will be kept confidential and may only be used only in accordance with applicable laws, executive orders and government regulations, including those which require the information be summarized and reported to the Federal Government for civil rights enforcement purposes. Providing this information below is optional and based on your self-identification. If you prefer not to disclose, please check the appropriate box.
Would Homeowner 1 qualify as? *
Required
Homeowner 1 Race Disclosure *
Homeowner 1 Ethnicity *
Would Resident 1 qualify as?
Resident 1 Race Disclosure
Clear selection
Resident 1 Ethnicity
Clear selection
Resident 1 Age
Resident 1 Gender
Relationship to Homeowner-Resident 1
Would Resident 2 qualify as?
Resident 2 Race Disclosure
Clear selection
Resident 2 Ethnicity
Clear selection
Resident 2 Age
Clear selection
Resident 2 Gender
Clear selection
Relationship to Homeowner- Resident 2
Please list any other household members' name, relationship to the homeowner, age, gender, veteran status disability status, race, ethnicity for this application.
Are there any hearing, vision, or speech issues that we may need to consider when interacting with residents in the home? If yes, please describe. *
Does someone in the home have a chronic or long-term health condition that affects ability to breath, reach, bend, walk, climb stairs or step over a tub or curb? If yes, please describe. *
Property Information
Type of Home: *
Year home was built: *
Year home was purchased: *
Was the home impacted by a natural disaster? *
If yes, what disaster and list year
Do you have a current homeowners insurance policy? *
Do you have other rental property? If yes, please describe.
Have you missed a mortgage payment in the last 12 months? If yes, how many have you missed? *
Are there existing liens on your property? *
Are your property tax payments current? *
Have you been cited by the city for any violations? If yes, please describe. *
Do you have plans to sell the home in the next 5 years? *
Social Services
Do you have a Social Worker/Case Manager? *
Social Worker/Case Manager's Name and Agency
Social Worker/Case Manager's Phone Number
Have you received any home improvement assistance from any other organizations? Please describe: *
Do you currently have an application with another organization for home improvement assistance? *
Authorization and Submission
Reminder to email proof of income to twalker@rebuildingtogethersa.org

WARNING!! It is a Federal crime punishable by fine and/or imprisonment, to knowingly make false statements concerning any of the above facts as applicable under the provisions of Title 18, US Code, Section 1014. 

IMPORTANT – READ CAREFULLY and SIGN AT THE BOTTOM: 

By submitting, I certify that I do not have the financial means (savings, investments, etc.) to perform the repairs for which I am applying. I certify that the above statements are true, accurate, and complete to the best of my knowledge and belief. This application shall remain the property of Rebuilding Together Affiliate, to which it is submitted for the purpose of obtaining assistance. I hereby consent to and authorize Rebuilding Together Affiliate, after providing me reasonable notice, to enter the property for the purpose of determining the need and scope of the repair(s) specified above. I authorize the disclosure of the above information to only those persons or agencies as necessary to secure the assistance for which this application is submitted. I understand that the submission of this application and any subsequent home assessments do not guarantee any repairs will be completed and any repairs to be completed will be dependent upon the funding available. 


I attest that my answers are true and fully represent the support needs of the person(s) listed above. *
Submission Date *
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A copy of your responses will be emailed to the address you provided.
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