Day of Caring PROJECT Application

Project Site Address

Applicant Information (person filling out this form)

First Name

Last Name

Address

City

State

Zip

Phone Number

Email Address

When is the best time to reach you?

Day

Evening

Please list the best day/times to have a Day of Caring representative visit for a project assessment?

Does your organization serve veterans or is anyone residing in the home a veteran?

yes

no

HOMEOWNER INFORMATION

Homeowner Name

Homeowner Phone Number

RENTAL INFORMATION (if applicable)

Landlord Name

Landlord Phone Number

Is the landlord aware of this application?

Renter Name

Renter Phone Number

ORGANIZATION INFORMATION (If applicable)

Organization Name

Organization Phone Number

PROJECT INFORMATION

Project Description

Please list in detail any equipment or supplies you may have or can supply for this project:

How much can you financially contribute toward this project?

Is there anything else you would like us to know about this project?

REVIEW AND ACKNOWLEDGEMENT

I certify that this application was completed by me and that all entries on it and all information in it are TRUE and COMPLETE to the best of my knowledge

i certify that this application is not requesting a roofing, plumbing, or foundation project

I understand that an application does NOT guarantee that this project will be accepted

Please provide your digital signature below.

Full Name

By entering my name below I certify that the information provided in this application is true and complete to the best of my knowledge

Please note that no roofing, plumbing, electrical or foundation projects will be accepted.