Homeowner Agreement
To be eligible to participate in the program, homowners must provide supporting documentation of:
- Verification of residence (i.e: water bill, light bill, etc.)*
- Must provide proof of total household income which inclues but is not limited to any income from pensions, 401k's, social security, SSI, Medicaid, HUSKY in the form of two most recent bank statements, and latest tax return.*
If you or anyone in your household are currently employed, please provide the two most recent pay stubs for each household member employed.*
Excluding home equity, total household income or asset level cannot exceed $6,000 a month.
Must provide a copy of your current homeowner's insurance declaration pages.*
Home must be located in one of the following CT towns: Bethel, Bridgewater, Brookfield, Danbury, New Canaan, New Fairfield, New Milford, Redding, Ridgefield, Roxbury, Sherman, Washington, Wilton and Weston.
**Before submitting proof of income, residence and homeowner's insurance, make sure to black out any sensitive information such as account numbers, social security numbers and account numbers.
I understand that by submitting this application, I am authorizing Housatonic Habitat for Humanity to evaluate my need for Aging in Place home repair or ADA modification. I understand that this evaluation will include persona visits and income verification. I have answered all questions truthfully. I understand by completing this application I am submitting myself and all persons listed to a background check by Housatonic Habitat for Humanity.
Aging in Place Homeowner Media Release & Partnership Acknowledgement Agreement
As a prospective homeowner for our Aging in Place - Basic Home Repair Program, partnering with Housatonic Habitat for Humanity (“Habitat”) and Habitat for Humanity International, I understand and acknowledge that my story is a powerful tool to inspire, educate, and engage the community.
By signing below, I commit to partnering with and hereby grant Housatonic Habitat for Humanity (“Habitat”) and Habitat for Humanity International, along with their partners, affiliates, contractors, agents, media representatives, and assignees, the irrevocable and unrestricted right and permission to take photographs, video recordings, audio recordings ,and/or written or oral testimonials of me and/or my partner/spouse, and to use such content for any lawful purpose.
I understand and agree that these materials will be used to:
● Advocate for affordable housing, critical home repairs, and safe living conditions for seniors and veterans
● Raise awareness of Habitat’s impact
● Encourage volunteerism and financial and gift-in-kind donations
● Attract future new homeowners by helping others connect to my experience
These materials may appear in:
● Print publications, brochures, flyers, signage, event displays, and other marketing materials that support our mission
● Online platforms, including Habitat’s website(s) and email communications
● Social media platforms, including but not limited to Facebook, Instagram, LinkedIn, and YouTube
● Press releases shared with or picked up by local/national media (TV, radio, online and print)
● Fundraising campaigns, grant proposals, reports, and event presentations
As part of my partnership with Habitat, I understand that:
● I will be asked to participate in interviews, provide written or video testimonials, and complete a post-project survey
● My feedback, story, and likeness will be used in full or in part, in edited or unedited form, indefinitely
● This participation is critical to the support of Habitat’s mission to serve more families and strengthen the community
I waive any right to inspect or approve the final use of these materials and understand that I will not receive compensation for their use. I hereby release and hold harmless Housatonic Habitat for Humanity and Habitat for Humanity International, and those acting on their behalf, from any liability relating to the use of such materials, including claims for libel, invasion of privacy, or
misrepresentation.
