Household application

Tell us what needs fixing and how to reach you. We only ask for what helps the team understand the need and decide on next steps.

Company

Are you applying as a homeowner or renter? *

HomeownerRenterLandlord approval may be needed before any repair work can happen.

Full name *

Phone *

Email (optional)

Street address *

City *

ZIP code *

Type of repair needed *

How urgent is the issue? *

LowMediumHigh

Describe what is happening *

How many people live in the home? *

Tell us about the hardship (optional)

Does anyone in the home have added risk from this issue?

Older adultYoung childrenDisabilityMedical vulnerabilitySafety concern

I understand landlord approval may be needed if I rent.

HomeWorks may contact me, and if I rent, may contact my landlord if needed.

Add a photo or document (optional)

JPG, PNG, WebP, or PDF. Maximum 6 MB.

I agree to the privacy notice. We collect only what we need to review requests, coordinate repairs, and run the organization. Your information is never sold and is never shared with a for-profit sales or marketing system.

I understand help is not guaranteed and this form is not for emergencies.

This form is not for emergencies. For a gas leak, flooding, electrical hazard, or immediate danger, call 911. For urgent local help, call 211.

Prefer to apply by phone? Call [phone coming soon] and a team member will walk you through the same questions.

What to expect

A short review by the HomeWorks team
A possible follow-up call for more detail
Renters may need landlord approval first
A case-by-case decision — help isn't guaranteed

Applying for a facility instead? Use the nonprofit form.

BrandenburgHomeWorks

Our IRS 501(c)(3) application is pending. We cannot assure that a gift is tax deductible unless and until the IRS grants exemption.

Founding sponsor: Brandenburg Plumbing, Heating & Air. The sponsor helped launch this work and may provide donated labor, materials, or operational support. This site never sells commercial services or routes applications into a sales pipeline.

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[phone coming soon]

hello@example.org