Apply For Home Modification | Building Homes for Heroes Inc

I have read and understand the above agreement requirements*
- Yes, I have read and I understand the requirements
Name*
First Middle Last
Date of Birth*
Social Security Number*
Current Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Mobile Phone*
Email*

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Provide an overview of exactly what your needs in a home are? (example: grab bars in the shower)*
Please provide pictures of existing area you wish to be modified
Drop files here or

Max. file size: 10 MB.
Current residence*
Other, please explain
Have you been charged or convicted of a crime? Answering "yes" does not automatically disqualify you.*
- Yes
- No
If yes, please explain. Answering "yes" does not automatically disqualify you.

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Have you ever filed for bankruptcy or had a home foreclosed?*
- Yes
- No
If yes, please explain
Please list all sources and amounts of household income.*
(If selected for one of our homes, you will be responsible for all costs associated with owning the home; taxes, utilities, HOA fees (if applicable), etc.)
Please list all of your monthly expenses and liabilities.*
(If selected for a home, you will be assigned a financial advisor that will ask you to verify this question. Please be detailed and include ALL debt)
Please tell us what your plans are for the future?*
Please tell us what receiving a home modification would mean to you and your family.*
Required Documents
DD Form 214*
Max. file size: 5 MB.
PDF preferred
Copy of Deed*
Max. file size: 10 MB.
PDF Preferred
Copy of Mortgage
Max. file size: 10 MB.
PDF Preferred

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Authorization to Release Information Waiver*
Max. file size: 5 MB.
PDF preferred
Photograph Release Waiver*
Max. file size: 5 MB.
PDF preferred

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Photographs
In the section below, please provide photos to help tell your story (i.e. before injury, during recovery, after recovery, family photos, military photos, etc.)
Photo #1*
Max. file size: 5 MB.
Please be sure to submit a high resolution photo.
Photo #2*
Max. file size: 5 MB.
Please be sure to submit a high resolution photo.
Photo #3*
Max. file size: 5 MB.
Please be sure to submit a high resolution photo.

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Photo #4*
Max. file size: 5 MB.
Please be sure to submit a high resolution photo.
Photo #5*
Max. file size: 5 MB.
Please be sure to submit a high resolution photo.
Photo #6*
Max. file size: 5 MB.
Please be sure to submit a high resolution photo.

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By typing my name I am signing the agreement below*
I certify that all statements made herein and on the enclosed application are true and correct to the best of my knowledge. I authorize investigation of all statements herein recorded. I release from liability all persons and organizations reporting information required by this application. I understand that if selected as a home recipient, any false, incomplete, or omitted information on this application will be considered sufficient dismissal from the program and may result in the loss of any gifted property as well as any civil remedies available at law.
Email
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Apply for Home Modifications Program