Online Application Form

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Serving Ingham, Clinton, & Eaton Counties in Michigan

PO Box 1111, Okemos, MI 48805-1111

rbttricounty@gmail.com

Application for Rebuilding Day Repairs

Applications are accepted year-round.

Applications received prior to October 1 will receive priority consideration for the following April's Rebuilding Day.

Homeowner (1)

Homeowner (2)

Date of Birth (1)

Phone (1)

Date of Birth (2)

Phone (2)

Email Address

Address

City

Township/Village

County

Zip

Emergency Contact

Relation of Contact

Phone (3)

Personal Reference (non-family)

Phone (4)

Monthly Income (include all sources and amounts)

Savings and Investments (other than income)

State Equalized Value (SEV) of Property

Do you own the home? *

Mortgage

Land Contract

Free and Clear

Are Property Taxes Current? *

Yes

No

Are you legally disabled? *

Yes

No

Do you have current home owners insurance? *

Yes

No

If Yes, what company?

Have you had help from this program before? *

Yes

No

Thanks for applying to volunteer with us! We'll get back to you soon.

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Contact Us

PO Box 1111

Okemos, MI 48805-1111

rbttricounty@gmail.com

517-455-5068

VOLUNTEER

We are always looking for board members and hands-on project team members. Email us with your interest!

Registered Charity Number : 38-3337416

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