Apply - if you have a problem filling out form please email: info@kingdombuilderscny.org

Application Date *

Name *

First

Last

Address of Residence *

Address Line 1

Address Line 2

City

State

Zip Code

County *

Email Address *

Age *

Phone *

Type of Phone Connection *

Cell
Home

Do you own and live in the home that is being considered in this application *

(If your home is a trailer, do you own the trailer even if you are renting the lot space)

We require home insurance for this application to be accepted! Is the property currently insured? *

Is this inquiry about a wheelchair ramp? *

You answered "NO" home ownership or insurance or "YES" to wheelchair ramp

You answered “No” to home ownership and or home insurance or "Yes" wheelchair ramp KBCNY is unable to assist you. We encourage you to reach out to your County Housing Department for assistance. Information is listed below. If you are applying for an outdoor handicap access ramp, please contact your County Housing organization below as they have programs to provide these on an expedited timeline.

Otsego- orha@otsegoruralhousing.org Otsego Rural Housing P.O. Box 189 Milford, NY 13807 (607) 286-7244

Chenango- theimpactprojectgreene.org The Impact Project 4 Clinton St, Greene, NY 13778 (607) 656-9499

Delaware- https://delawareopportunities.org Delaware Opportunities Inc. 35430 State Highway10 Hamden, New York 13782 Phone: (607) 746-1600

Total Household Monthly Gross Income (all residents 18 or older) *

Total Number of Income Earners

Total # Household Residents *

Household Members (Other than Applicant) Information:

Name

Age

Relationship to Applicant

Name

Age

Relationship to Applicant

Name

Age

Relationship to Applicant

Name

Age

Relationship to Applicant

Mission Statement: KB of CNY ministry exists to serve homeowners in the greater Oneonta area by providing quality labor to address construction needs that they are unable to accomplish by their own means. Although the practical focus is on construction, the spiritual focus is on building relationships with those served, with the end goal of demonstrating the love of Christ through ministry.

Modifications or Repair Description

What modifications or repairs are needed? *

Home Type *

Frame
Mobile Home

Number of stories *

Year Home was Built: *

Do you own property other than your residence? *

Do you currently have a lien/mortgage on this home? *

Are Payments up to date and current? *

Are the taxes paid up to date? *

Do you have any renters? *

Do you have any dogs on premise? *

If yes, how many?

Breed of Dogs

How did you hear about Kingdom Builders? *

Kingdom Builders Website
Your church
Office of the Aging
Other

If selected "Other" please tell how you heard about us?

Have you ever applied to Kingdom Builders in the past? *

Have you applied to any other agencies for help with these problems on your home? *

I/we certify that: 1) I/we own the property this property or I/we have been granted lifetime residency in the property.

2) All statements on this Application are true, accurate, and complete to the best of my/our knowledge and that any intentional misrepresentation of material information contained on this form will be grounds for disqualification.

3) My/our permission is granted to allow KB of Central NY to have access to my home o plan modifications and other improvements.

4) I/we grant KB of Central NY permission to take beginning, progress, and after photos of work done on my home.

Signature *

Date of Signature

Apply – if you have a problem filling out form please email: info@kingdombuilderscny.org

You answered "NO" home ownership or insurance or "YES" to wheelchair ramp