thanks for your interest in critical home repair
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Lead Status
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Open - Not Contacted
Company
Record Type ID
Lead Record Type Input
Unfortunately, due to the overwhelming demand, we have currently paused all new Critical Home Repair applications in your area. If you would like to be notified when applications in your area become available
please fill out the interest/referral form below.
Someone from our Critical Home Repair Family Services team will follow up with you on details on how to apply as soon as your area becomes available for applications.
Please note that this form is
NOT
an application and does not guarantee that you will be served in our Critical Home Repair program.
If you have any questions or concerns, please call the Critical Home Repair hotline: 704.716.5639
IS THIS A CRITICAL HOME REPAIR INTEREST FORM FOR YOURSELF OR A REFERRAL FOR SOMEONE YOU KNOW?
MYSELF
SOMEONE ELSE
Person filling out this form
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Last
Phone
Email
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HomeOwner Name
First
Last
Phone
Email
Enter Email
Confirm Email
Who should we use for the primary contact?
Homeowner
Person Filling Out Form
STREET ADDRESS
CITY
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Charlotte
Cornelius
Davidson
Harmony
Huntersville
Mooresville
Pineville
Statesville
Stony Point
Troutman
Note: Home must be in Charlotte, Pineville, Mooresville, Troutman, Cornelius., Davidson, Huntersville, or Statesville to qualify for Habitat Charlotte Region’s Critical Home Repair.
STATE
ZIP CODE
Please select...
28031
28035
28036
28070
28078
28115
28117
28123
28134
28166
28201
28202
28203
28204
28205
28206
28207
28208
28209
28210
28211
28212
28213
28214
28215
28216
28217
28218
28219
28220
28221
28222
28223
28224
28226
28227
28228
28229
28230
28231
28232
28233
28234
28235
28236
28237
28241
28242
28243
28244
28246
28247
28253
28254
28255
28256
28258
28260
28262
28263
28265
28266
28269
28270
28271
28272
28273
28274
28275
28277
28278
28280
28281
28282
28284
28285
28287
28288
28289
28290
28296
28297
28299
28625
28677
28687
28678
28634
LANGUAGE PREFERENCE
ENGLISH
SPANISH
FRENCH
ARE YOU A VETERAN OF THE U.S. ARMED FORCES?
Yes
No
Contact Information