2018 Homeowner Application

Make sure to read up on our program qualifications and eligibility requirements!

Deadline - May 1, 2018
Questions? Call 612-276-1548


Name *
Name
Address *
Address
Phone 1 *
Phone 1
Best number to reach you at
Phone 2
Phone 2
Eligibility *
Those aged 60 and older and eligible. Individuals younger than 60 with a permanent, physical disability are also eligible and must attach a physician's statement defining the disabiliy.
Emergency Contact
please list a relative, neighbor or friend
Name *
Name
Phone *
Phone
Household
Number of dependents/children and roomates/renters/partners living with you
If there are other adults, can they help paint? *
Monthly Income Calculation
$
$
$
$
$
$
$
Your Home
Which best describes the size of your home where the painting is needed?
It is very important that the volunteers have access to a bathroom.
Areas that need painting: *
mark all that apply
Demographic Information (optional)
We appreciate you providing the following information for our grant reporting. This information is for statistical use only and will not in any way influence the selection process. Please check the categories that best represent you.
Check all that apply:
Certification and Signature: Homeowner Signature #1 *
Certification and Signature: Homeowner Signature #1
I certify that the information in this application is true to the best of my knowledge and belief. I also certify that I do not plan or intend to sell my home within the next two years. I am aware that I will be charged for the costs of the paint and the time should the house be sold within two years from the date painted, unless it is determined that there are extenuating circumstances. I confirm that any physically able person(s) residing in my home or visiting for the project day will work alongside Paint-A-Thon volunteers. I also confirm that , except for conditions that my be described in this application, my home and the surrounding area is a safe place for volunteers. I understand that my home may be tested for the presence of lead-based paint by the PAT home inspector. I am aware that the PAT director may refer my application to a partner organization if that group can more quickly and effectively care for my home and that I will be notified in the evet that happens. I understand that if my home is selected, photographs may be taken of me and/or my home, and these photographs may be used by the news media and/or in publications and materials to help promote Metro Paint-A-Thon and/or the Greater Minneapolis Council of Churches. I understand that the people who may work on my home are unpaid volunteers; that few (if any) of these volunteers are skilled in the building trades; and that Metro Paint-A-Thon and the Greater Minneapolis Council of Churches, make no warranties or representations, express or implied about any of the material(s) used or work done by anyone on my house. I hereby release Metro Paint-A-Thon and the Greater Minneapolis Council of Churches and all associated with it from all liability arising from negligence for any personal injury or property damage arising out of or relating to the work done on my house. I further certify that I have and will maintain homeowners insurance.
Date *
Date
Homeowner Signature #2 (if applicable)
Homeowner Signature #2 (if applicable)
Date
Date
Complete if you are a non-homeowner assisting the homeowner in completing this application
Complete if you are a non-homeowner assisting the homeowner in completing this application
Date
Date