Home Improvement Application
Date: _________
Name: _____________________________________________________
(Please print)
Married ________ Widowed _______ Single ________
Number of dependents in household: _________
Address: ___________________________________________________
Phone: ____________________________________________AM / PM
Work Needed (please mark boxes to indicate need):
q Painting (Outside)
q Painting (Inside)
q Ramp
q Deck/Porch repair
q Windows
q Painting
q Basic Electrical
q Basic Plumbing
q Winterization
q Windows
q Other______________________
_____________________
Please give details if possible: ___________________________________________________
____________________________________________________________________________
What materials and Labor could you provide: _______________________________________
Please state reason assistance is needed: ____________________________________________
Do you own the house for which you are asking repairs? ______
Is this your primary residence? ______ Is this a rental property? _____
If you rent the house from who do you rent? ________________________________________
Landlord’s phone: ________________________________________
All of the stated information is accurate to my knowledge.
Applicant’s signature: _____________________________________
I agree to and understand the following when applying for and receiving assistance from the “Together for Lincoln” program:
I understand that simply applying for assistance does not guarantee that “Together for Lincoln” will be able to fill my request.
1. I understand that everything asked for on the application may not be done to my house and that often only some of the asked for assistance is received.
2. I agree to have someone present at my home during the time work is being done.
3. I understand that sometimes a volunteer group may start a project and due to uncontrollable circumstances may not be able to finish the project. I also understand that “Together for Lincoln” will try to finish the work, but they do not promise or guarantee that a project will be finished on time.
They will make every effort to complete the project as soon as possible.
4. I understand that pictures may be taken of projects at my home, and may be used to promote in a
positive manner the ministries of church groups/“Together for Lincoln.”
5. I understand that pictures may be taken of projects at my home, and may be used to promote in a
positive manner the ministries of church groups/“Together for Lincoln.”
6. This Hold Harmless, Covenant Not to Sue and Indemnification Agreement is entered into on
___________, between “Together for Lincoln”, the "Volunteers," and the Owner(s) of the property:
______________________________________________________________________________
Now, therefore, in consideration of the Volunteers performing such work at no charge, the parties do
agree: Owner, for himself, and for his heirs, assigns, guests and invitees, covenants not to sue the
Volunteers for any reason, including, without limitation, negligence and failure to perform in a
workman-like manner, in connection with the performance by the Volunteers under this agreement.
Owner, for himself, and for his heirs, assigns, guests and invitees shall hold the Volunteers harmless
and indemnify them from any and all liability for any reason, including, without limitation, negligence
and failure to perform in a workman-like manner, in connection with the performance by the Volunteers
under this agreement.
Applicant’s Signature: ____________________________________ Date:________________
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