Online Assistance Application

Before you proceed to the online application, answer these questions:

Are you a military veteran, a retired public safety officer, or a surviving spouse?*

Yes
No

• If veteran or surviving spouse, please provide a copy of the veteran’s DD214
• If retired public service officer or surviving spouse, provide proof of retirement or service record

Do you live in and own your own home?*

Yes
No

Does your home need minor repairs?*

*If your home needs major work such as a new roof, walk in shower or anything structural you do not qualify for this program. Our program is designed to assist with minor repairs by using unskilled volunteers to do the labor. We have a very small budget to purchase supplies. Please keep this in mind before your proceed to the application process.

Yes
No

Veteran or Public Safety Officer Name

First Last

Veteran's/Officer's Date of Birth*

Annual Household Income*

Is the Veteran or Public Safety Officer deceased?*

Yes
No

• If yes, please provide a copy of the death certificate.

Spouse's Name

First Last

Street Address*

City*

State*

Zip*

Phone Number*

Email Address*

What is the best time to contact you?*

By phone or email?*

Did, or does, the veteran/public safety officer live in this home?*

Yes
No

• Please provide a copy of your warranty deed.

If Yes, for how long?*

How many people live in this home?*

Please provide their ages and relationship to the veteran/public safety officer below.*

Has House of Heroes previously done work on your home?*

Yes
No

Are there any health issues we should be aware of?*

Yes
No

If yes, please provide details below.*

Needs: What are the top 5 needs you would like us to consider? Please rank from 1 to 5, with 1 being the top priority.

Interior cleaning

Gutters

Trash removal

Painting: Interior

Painting: Exterior

Plumbing fixtures

Flooring

Handicap fixtures

Handicap ramp

Interior doors

Windows

Porch railing

Pressure washing

Other

Once work is completed, we conduct an honor ceremony at your home. Please provide the following information for this purpose.

Family: Children (Names and Ages)

Where and when did you meet spouse?

Date of marriage:

Branch of Service

Last rank held*

Date applicant entered active duty*

Units served in

Occupation when entering service*

Combat veteran?*

Yes
No

Combat zone(s) and/or war(s) service in*

Number of years served*

Disabled?*

Yes
No

If disabled, is it service related?*

Yes
No

Date of retirement or honorable discharge

Special memory and/or event of applicant (military or civilian)

Awards and/or decorations

House of Heroes Chattahoochee Valley Mission
The mission of House of Heroes Chattahoochee Valley Chapter is to honor our military veterans, and/or their spouses as well as our public safety officers by performing minor repairs to their homes. House of Heroes-Chattahoochee Valley Chapter, Inc. is a community program that provides free home repairs as a way of saying “Thank you” for service to our country. I certify that I own and live in the home represented, and that all of the above information is true and correct.

Date*

Electronic Applicant Signature*

First Last

Number

Cart

Before you proceed to the online application, answer these questions:

You answered "No" in one of the questions above, therefore will will not be able to process your application at this time.

Thankful for Our Sponsors!