Windy City Habitat for Humanity (WCHFH) is a non-profit organization building affordable homes and providing exterior
home repairs for low-income families. A Brush With Kindness (ABWK) is a program that provides exterior home repair
for low-income families. Home improvements are completed in exchange for volunteer hours, or “Sweat Equity.” The
number of Sweat Equity hours will vary depending on the scope of each project.
WCHFH is currently running a pilot program of ABWK. After the pilot program is complete, the program will be
evaluated and may be continued as a permanent service. The following details apply to the pilot version of the ABWK
1. Repair work will be focused in the 34th ward of the South Side of Chicago. Homeowners from other areas of
Chicago may still apply to the program. Qualified applicants from outside the 34th ward may be approved as
funding and construction schedules allow.
2. If the number of qualified applicants exceeds available funding for the pilot program, all applications may not be
accepted. If this is the case, qualified applicants who are not accepted into the pilot program will automatically
be considered for repair services at a later date, as funding and scheduling allows.
3. Completed applications for the pilot program must be received by 5pm on Friday, October 12. Incomplete
applications, or applications submitted after this date, will not be considered for Winter 2012/Spring 2013 repair
4. Applicants to the pilot program will be notified of the status of their application by Friday, November 9.
5. Repair work is expected to take place beginning in December 2012 and will run through the Spring of 2013.
1. Read ALL the information before completing the application.
2. Complete the application fully and honestly. All information is confidential and seen only by the Habitat ABWK
Committee Members, staff and Board of Directors.
3. Habitat considers an application complete ONLY when the completely filled out and signed application is
submitted with all necessary forms & documents, including tax forms and income documentation. If you do not
file income tax forms with the IRS please include a note explaining why.
4. Return your completed application and additional materials to the WCHFH office in Chicago.
5. The deadline for the ABWK Pilot Program is 5pm on Friday, October 12. Completed applications must be
submitted by this date to be considered for the Winter 2012/Spring 2013 repair schedule.
1. REVIEW: The ABWK Committee will review your application. If you are not eligible for the program, you will be
notified by mail. If the committee decides to move forward in data collection, you will be contacted to schedule
a home visit.
2. HOME VISIT: If you DO meet the financial eligibility requirements, a WCHFH representative will contact you to
take the next step, a home visit. The purpose of this visit is for an ABWK Committee Member to answer your
questions about the program and review the needed repairs on your home.
3. NOTIFICATION: Once all data is collected your application will once again be presented to the ABWK Committee
for a final review. You will be notified by mail if you are or are not eligible to participate in ABWK program. If
approved for the program, you will be notified via a phone call and an acceptance letter via mail.
4. HOMEOWNER’S AGREEMENT: In order to finalize a date and plans for repairs to your home, you must sign a
Homeowner’s Agreement, which will serve as a legal contract between you and Windy City Habitat for
Humanity. Failure to sign this document will result in removal from the program.
NOTE: If you are turned down at any point in the process, we will tell you exactly why. You may still be eligible at some
time in the future. If your circumstances change, we encourage you to apply again.
If your family qualifies for the ABWK program, you will continue building relationships with Habitat for Humanity. You
and Habitat will become partners in every stage of planning and staging repairs to your home. You will work alongside
WCHFH volunteers, partner families, sponsors & staff in the completion of the updates and repairs to your home.
If you have questions about your application contact us at 312-563-0296 x15.
You must meet Habitat’s 3 basic guidelines (Need, Willingness to Partner; Financial Eligibility) to be eligible for ABWK
program with WCHFH:
Application must describe conditions that merit intervention by ABWK, as well as an inability to remedy due to
age, infirmity or lack of funds.
Qualifying conditions would include damaged siding, extensive areas in needs of paint, missing or damaged
gutters and fascia, minor structural damage (broken porch step, missing railing spindles, non-structural roof
repair, etc.)
You are willing to be a partner with WCHFH and contribute “sweat equity” in support of the Habitat mission.
You must live in the City of Chicago and be the homeowner and resident of the home in need of repair.
Your income must be at or below the 65th percentile of the area median income of Chicago. The chart below
details these income levels for various family sizes.
Homeowners that remain in their homes at least 3 years after the date of repair will owe no money to WCHFH.
If the home is sold in the 3 years after the date of repair, a portion of the proceeds will be owed to WCHFH
Family Size
Maximum Income
Possess, or be willing to acquire, current homeowner’s insurance.
Complete “Sweat Equity,” helping with your home and/or make other arrangements.
Retain ownership of your home for at least 3 years following the date of repair.
Application Checklist
Please stop by or mail your completed application to the WCHFH office. You must bring or mail in all of the following
documents that apply to you. We will make necessary copies at the office, if needed. Remember that applications are
screened in the order they are received. Check off the documents that apply to you in the list below and be sure to
submit them with your application. Your application is not complete without ALL the documents that apply to you.
The following items must be included in your application for full consideration. All applicants must provide this
information to the best of their ability. If you do not have some of this information, you must include a written
explanation in order for your application to be processed.
Included or
All income documentation (items marked with stars in the list below) must be provided for all members
of the household over the age of 18.*
Most recent IRS Federal tax returns (If you do not file taxes, include a note of explanation)*
Last three (3) months official bank statements of all checking & savings accounts*
Proof of homeownership (This may include a copy of the Deed of Trust or most recent Property Tax
Receipt.) All documents must include the name and address of the applicant.
Proof of current homeowner insurance
Complete all sections of the application
Sign and date the application
Sign and date the Homeowner’s Statement of Eligibility
We recognize that there may be applicants to this program who are not currently employed or receiving income in the
form of paychecks. To evaluate your application fully, we must document all forms of income within the household
by reviewing various types of income verification. The following items must be included in your application if they
apply to you (If items do not apply, check the N/A column):
Included N/A
All income documentation (items marked with stars in the list below) must be provided for all
members of the household over the age of 18.*
Eight (8) weeks of most recent payroll stubs from each place of employment. If you are selfemployed, we must have valid verification of business income and expenses.*
Most recent W-2 tax form(s) (usually with Federal tax returns)*
Verification of all unearned income (SSI, social security, FIP, Section 8 Housing, rental
reimbursement, student loans, etc.)*
Verification of food stamps*
Child support verification (this is optional to report, but if you report it we must have
Verification of any other income not listed above*
For Office Use Only
Mail or fax completed form to:
Date Received:
Windy City Habitat for Humanity
City Citation:
Attn: ABWK
Referred By
2201 S Halsted, Suite 1251
Phone No.
Chicago, IL 60608
Application No.
fax: 312-563-0297
A Brush with Kindness is a program of Windy City Habitat for Humanity that does home painting and exterior home repairs for lowincome homeowners who need assistance to do necessary work. Call 312-563-0296 x15 with any questions.
SECTION 1 - Homeowner Information
Legal Name of Homeowner:
Home Address:
Telephone Numbers:
Please include area code
Number of Years at Address:
Name of Neighborhood:
List the names, ages, and relationship to homeowner of all people living in the home
(attach a list if more space is needed):
Name/relationship: _____________________________________
Age: _________
Name/relationship _____________________________________
Age: _________
Name/relationship _____________________________________
Age: _________
Name/relationship _____________________________________
Age: _________
Is anyone in your household a veteran?
Yes No
Name ___________________
Is anyone in your household currently in the military? Yes No
SECTION 2 - Special Needs
Is the homeowner or anyone in the home disabled?
 No
If yes, indicate the type of disability below (check all that apply, please describe if “other”):
 Uses a Walker, Cane or Crutches
 Loss of Limb
Is translation needed?
 Wheelchair Bound
 Mentally Disabled
 Blind
 Hearing Impaired
 Other: _________________________________
 No
If yes, what language: __________________
SECTION 3 - Household Income and Mortgage Information
The total, combined income before taxes for ALL persons living in the home is: $__________ per year
You must attach verification of all HOUSEHOLD income for each adult in the house.
Are you still making loan payments on your home?
 
If yes, what is your monthly payment? $__________ / month
After paying your monthly bills (gas, electric, insurance, food, phone, medical, etc.), approximately how much money
do you have left to spend on house repairs? $__________ / month
SECTION 4 - Sharing Your Personal Information
If your application is a more appropriate fit with other, similar programs may we share it with them?
Yes  No
Unless you give us permission to share your information with other organizations, your application will be kept
confidential. If you check yes, you give A Brush With Kindness your consent to share the information you provide on
this application with similar organizations if A Brush With Kindness is not able to assist you.
SECTION 5 - Homeowner’s Agreement
I certify that the information on this application is accurate and that I own the property at the address given
on this application. I have no present intention to move or offer my home for sale for at least three years. I
confirm that any physically able persons residing in my home or visiting for the project day(s) will work
alongside the A Brush with Kindness (ABWK) volunteers. I confirm that, except for the conditions listed
above, my home is a safe place for volunteers. To the extent permitted by law and without affecting the
coverage provided by the required homeowners insurance, I agree to sign the release and waiver of
Complete the following if you are not the homeowner, but are assisting the homeowner in completing this application.
Your name:
Your daytime phone number:
Is homeowner aware of this application?
 No
SECTION 6 - House Information / Exterior
Place a large “X” over the house (below), which
most resembles the size of your house.
Year Purchased: ______ Year Built: __________
Last Painted: _______ Square Feet: ________
House Exterior
 wood
 wood
 brick
 vinyl
 shakes  metal
painted stucco
Garage Exterior
 wood
 wood
 brick
 vinyl
 shakes  metal
painted stucco
 N/A – No Garage Repair
SECTION 7 - Requested Repairs
Briefly describe the type of work you would like done on your home. Attach a separate piece of paper if there is not enough space to list all
repairs. Remember that the items listed below will be considered for repair, but the final decision on what work can be done with our time and
financial resources will be made at the discretion of A Brush with Kindness. The work done by A Brush with Kindness will focus on warmth,
safety and independence. Our volunteers are not professionals and may not be able to make all repairs. Please print
Area of Repair
Accessibility Modifications. Examples: wheelchair ramps, porch
Would you like an assessment? Yes No
Carpentry Repairs. Describe problems with doors, porches, steps,
etc. Indicate places on house exterior or garage needing repair.
Roofing Repairs. Identify where roof leaks, or describe additional
roofing concerns.
Painting. List any exterior painting requirements.
Exterior Siding. Describe repairs required.
Driveways and Walkways. Describe repairs required, including type
of material (brick, concrete, asphalt, etc.).
Doors and Windows. Describe repairs required, including locks,
glass, etc.
Landscaping. Indicate if there is cleaning and/or trash removal
required. Identify if yard work is necessary.
Other. Identify other repairs requested but not listed above.
SECTION 8 – Application History
Have you applied to ABWK in the past?  Yes  No What year(s)?_________
Has ABWK done work at your home in the past?  Yes  No Year(s)?________
SECTION 9 – Media and Publicity
Where did you learn about A Brush with Kindness?
☐TV ☐Radio ☐Newspaper ☐Flyer ☐Friend ☐Neighbor ☐Neighborhood Organization
☐OTHER (please describe):__________________________________
If ABWK selects your house to be repaired, pictures of you and your home may be taken. Are you willing to be
interviewed by media reporters? May we bring elected officials to your home?
☐ YES Interviews are okay
☐ NO I do not want interviews
☐ YES Visits by elected officials are okay
☐ NO I do not want visits by elected officials
SECTION 10 – Personal Statement
Please write a brief explanation of why you feel you should be selected and how it will help you.
SECTION 11 – Homeowner’s Statement of Eligibility
I, ____________________________________________ have asked Windy City Habitat for Humanity to provide
repairs to my home at _____________________________________________________ in Chicago, IL. I understand
that Windy City Habitat for Humanity is funded by charitable donations and grants to provide assistance to lowincome, elderly, or disabled homeowners who have no other means to afford home repairs. I also understand that
Windy City Habitat for Humanity is obligated to use its charitable donations only for assistance to eligible
homeowners. I understand that by filing this application, I am authorizing Windy City Habitat for Humanity to
evaluate my actual need for home repair, as well as my willingness to be a partner family. I have answered all the
questions on this application truthfully. I understand that if I have not answered the questions truthfully, my
application may be denied, and that even if I have already been selected to receive home repairs, I may be
disqualified from the program. The original or a copy of this application will be retained by Windy City Habitat for
Humanity even if the application is not approved. By signing my name to this statement, I guarantee that I am
eligible to receive this assistance, as follows:
1. All the information submitted on my Homeowner Application is complete and correct. _______ Initial
2. I am the owner of the home at the above address. _______ Initial
3. This same house is my full-time residence. _______ Initial
4. I will not sell, rent or transfer ownership of this house for three years after completion of repairs.______
5. I, my spouse, partner and/or any other owners of my home have no other financial resources to afford the
services that I have requested. _______ Initial
6. I authorize Windy City Habitat for Humanity and its representatives to complete paperwork required to
obtain building permits necessary to repair my home. _______ Initial
7. I understand that Windy City Habitat for Humanity is a neighbor-helping-neighbor organization and I will
do everything possible to get my friends and family to help on the workday. _______ Initial
8. I am aware that Windy City Habitat for Humanity is a volunteer program. Promises cannot be made as to
the specific work that will be done. I understand it may not be possible for the same volunteers to return
after the initial work day. _______ Initial
9. I authorize Windy City Habitat for Humanity to verify any information I have provided on this application.
_______ Initial
10. I will take full responsibility for securing valuables located in and around my house when volunteers are
working in my home. I understand Windy City Habitat for Humanity cannot be held responsible for
misplaced or broken items. _______ Initial
Signed: ________________________________________
Date: _________________________
SECTION 12 – Application Verification
 Did you complete all sections of this application?
 Did you sign the application? (SECTION 5, SECTION 11, AND SECTION 12)
 Did you enclose copies of required documentation? See the Application Checklist on page 3 for details.
 Did you complete and sign the Homeowner’s Statement of Eligibility? (SECTION 11)
 I verify that this application is truthful and complete.
Signature: _____________________________________________________ Date: _______________________