Habitat for Humanity 
of Huron Valley
Veteran Repair Interest Form
Please Note: It Is Important to Make Sure That All Applicable Information Is Complete Before You Submit This Intake Form. Incomplete Intake Forms Will Not Be Processed.
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APPLICANT

Do you live in Washtenaw County? *
Are You (the Applicant) a U.S. Military Veteran? *

Household Information

Have you ever received assistance from Habitat for Humanity of Huron Valley? *
Check all that apply: *
Please List Amount of Income Received Each Month from the Following Sources (If Applicable) 
** You will be required to provide documentation of this income.
Please List Amount of Income Received Each Month from the Following Sources (If Applicable) 

CONTACT INFORMATION

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Complaint Procedure
 
Habitat for Humanity of Huron Valley hereby establishes a complaint procedure for all complaints, other than those related to Fair Housing issues, which will be covered by the Habitat for Humanity of Huron Valley Fair Housing Policy.
 
Habitat for Humanity of Huron Valley will distribute a copy of its complaint procedure to all participants in its programs, to all parties contracting for work, and to all parties filing a written complaint.
 
Habitat for Humanity of Huron Valley will ensure that an initial complaint is responded to by the program administrator within 15 working days of the date of the complaint.
 
Habitat for Humanity of Huron Valley will require that the Executive Director be informed of the complaint if the program administrator fails to resolve and recommend a resolution.
 
Habitat for Humanity of Huron Valley shall provide for the establishment of a review committee to be comprised of at least three people, which must hear all cases that cannot be successfully resolved by the program administrator (and Executive Director if he/she is part of the complaint procedure).
 
The claimant may choose to make a presentation or submit a written description (including documentation) to the committee for review.
 
Habitat for Humanity of Huron Valley shall notify the client in writing of the review committee's decision within 15 working days of the date of the hearing.
 
Habitat for Humanity of Huron Valley shall refer the dispute to the Dispute Resolution Center if the conflict is not satisfactorily resolved.
 
The Dispute Resolution Center
4133 Washtenaw Ave, Suite B125
Ann Arbor, MI 48107
734-794-2125 or drc@ewashtenaw.org
 
How to File a Complaint with Habitat for Humanity of Huron Valley
 
Please send your written complaint to:
 
Sarah Teare, Community Development Director
170 Aprill Drive Suite A
Ann Arbor, MI 48103
steare@h4h.org

I understand the need to share necessary personal information with Habitat staff in order to determine my eligibility for a Habitat for Humanity Veteran Repair. I understand and acknowledge that completing an intake form and initial assessment does not guarantee that I will be approved for a Habitat for Humanity Veteran Repair. 
I understand that my personal information will be kept confidential and will only be shared between Habitat for Humanity office staff and designated volunteers. I understand that I may terminate my participation in this program at any time by contacting Habitat for Humanity.