Homeowner Eligibility Guidelines
Do you meet these guidelines?
What You Need to Apply
Submit your completed application with ALL DOCUMENTS LISTED for all owners and residents of the home.
Your application will not be processed until all documents are received.
How did you hear about us?
Name
*
First Name
Last Name
*
Date of Birth
MM
DD
YYYY
*
Sex
Spouse or Co-Owner's Name
First Name
Last Name
Date of Birth
MM
DD
YYYY
Sex
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone Number
(###)
###
####
*
Cell Phone Number
(###)
###
####
Alternate Contact Name
First Name
Last Name
Phone
(###)
###
####
Do you have a care manager?
*
Care Manager Name
First Name
Last Name
Care Manager Phone Number
(###)
###
####
*
Marital Status
Did/do you or a family member serve in the military?
*
*
Is this your only residence?
*
Do you own any other property?
*
Do you plan to sell your home?
If yes, when?
*
Is any portion of this property rented? Note: Only the unit of the home occupied by the owner will receive services.
*
Do you receive rental income?
*
Is your home in a Trust or a life estate?
*
Are you in foreclosure?
*
Have you filed for bankruptcy?
*
Are you still making mortgage payments?
*
Does this include property taxes?
*
Have you missed any mortgage payments in the last 6 months?
*
Would hiring a private contractor for your repairs prevent you from being able to pay your mortgage?
Are your property taxes current?
If no, are you on an installment plan? (If yes, must include documentation of this with application.)
Did you file income tax last year?
*
Sign below certifying that this is this is true. If this is found to be false, you will be removed from the program.
I certify this information is true
*
*
Do you have electricity in all rooms of the home?
Do you have running water in the kitchen and bathroom?
If your bathroom does not have running water, is this your only bathroom?
*
Do you have at least one functioning toilet?
What are the physical challenges you have while living in and moving around your home?
*
*
Do you have anyone to help you with household chores, errands, or transportation?
*
Does your hot water heater work?
If no, is the hot water heater:
*
Are there any pests (example: roaches, mice, bedbugs) in your home?
*
Do all entry doors lock?
*
Have you had any falls in the home?
*
Is the temperature in your home comfortable?
*
Are you energy bills extremely high?
*
Are you on Energy Assistance?
*
Has your home been weatherized?
What are your top 4 priorities for repair or assistance?
*
Lawn
Snow
Please indicate your needs below.
Thank you for submitting your online application. To finish your application make sure you submit all documentation.
□ Download, fill and sign this document
□ The past 3 months of itemized bank statements for all checking & savings accounts for all owners and residents.
□ A recent mortgage statement if you are still making payments.
□ The federal income tax return for all owners and residents who filed taxes the past year.
□ WE Energies statement from the last month.
HOW TO SUBMIT YOUR APPLICATION
Mail:
Revitalize Milwaukee, 840 N Dr. Martin Luther King Jr. Drive, Suite 600 Milwaukee, WI 53203
Email: Clear scans of each page to: applications@rtmilwaukee.org with the subject line “RM Application Submission”
Dropoff: Call (414) 312-7531 to schedule a time to drop off in mail slot of the Revitalize Milwaukee office door.
