Background pattern Sharing with Appalachian People (SWAP) SWAP Home Repair application Sharing With Appalachian People (SWAP) is a home repair program that serves low-income families in Appalachia. SWAP Homeowner application You must have JavaScript enabled to use this form. Sharing With Appalachian People (SWAP) is a home repair program that serves low-income families in Appalachia. SWAP receives far more home repair applications each year than it can possibly complete or follow up on. We apologize in advance if you are not contacted this year. Please submit another application next year if assistance is still needed. Location - Select -McDowell County, West VirginiaPike County, Kentucky Contact information Full name Phone Email Mailing address City State - Select -KentuckyWest Virginia Zip Street address If different than mailing address City State - None -KentuckyWest Virginia Zip Birthdate Directions to home from county seat Description of house, landmarks Home information Home type - Select -Own houseRent HouseOwn trailerRent trailer Do you have a deed to your home? - Select -YesNo Do you have city water? - Select -YesNo Do you have city sewer? - Select -YesNo Have you applied to another organization this year? - Select -YesNo Home repair requested Priority area for repair: Please select the greatest need Foundation Underpinning Siding Windows Roof Doors Floors Walls Insulation Handicap ramp Other If "other" selected above, please explain: Work requested: Please provide a full description of the work you need help with Other comments Household information Total number of people in the household Number of household members with disabilities Number of household members who are elderly (65+) Applicant's marital status - Select -SingleMarriedWidowedSeparated/Divorced Household members Household member #1 name Household member #1 age Household member #2 name Household member #2 age Household member #3 name Household member #3 age Household member #4 name Household member #4 age Household member #5 name Household member #5 age Household member #6 name Household member #6 age Household member #7 name Household member #7 age Household member #8 name Household member #8 age Total monthly household income $ Include all sources of income, including Social Security, SSI, alimony and other benefits of everyone living in the house. Has SWAP worked on your home in the past? - Select -YesNo Other information Helping pay some of the material expenses allows us to help more people. Please tell us how you can help by filling in the boxes below: I can pay for building materials In full Payments towards full cost Provide building materials Contribute a set amount Other… Enter other… Amount I can also help: Contribute labor Provide coffee breaks for volunteers Provide lunch for volunteers Chat with volunteers about Appalachia Please check all that apply. I understand that preparing the site for the workers safety, and site clean-up and trash disposal are my responsibility. Permission to use photos and names We like to take pictures of the SWAP workers doing repairs on your home. If these pictures are used in our promotional materials you and/or your family will be shown in a favorable manner. Our consideration of your application does not depend on your agreeing to let us use photos of your project. I give SWAP permission to use photos of the work on my home in promotional materials. - Select -YesNo I give SWAP permission to use my name in promotional materials. - Select -Yes, I give permission to use both my first name and last name.I give permission to use my first name only.No, I do not want my first or last name to be used. E-Signature By entering your name here, you confirm that this information is accurate to the best of your knowledge. Give a gift where needed most Every gift makes a difference. Donate $50 Donate $100 Donate $250 Custom donation amount
