Home Repair Application Form

General Information

Printable McDowell County Home Repair Application
Printable General Home Repair Application
Head of Household Contact
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Property Location
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*   *required for US or CA only
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Mail To (if different from above)
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    Yes     No
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EM will only do this if another organization may be able to help.
    Yes     No

Household Information

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For informational purposes only, will not affect selection process.
    Yes     No
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For informational purposes only, will not affect selection process.
    Yes     No

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Provide full names and birth year of everyone residing in the home. Please also indicate if they are a military veteran.
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    Yes     No
*
    Yes     No
Note: Experience Mission is not always able to cover all materials costs. If you are not able to help with the purchase of materials this could affect your house being selected.
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Home Details

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Explain:
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*     Yes     No
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Explain:
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Explain:
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Repairs Requested

Please prioritize the needed repairs on the home and describe the top four repairs you would like to submit in this application.





Miscellaneous





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