Home Repair Application Request Form






Do you own the home?  Yes No
Is this your primary address?  Yes No
Number of people living in the home?
How many are over the age of 18?
Are property taxes paid/up-to-date?  Yes No
Do you have homeowner’s insurance?  Yes No
Total estimated annual income for household?



Helping with home renovations and improvements

How to Apply

  • Request application online
    Request Application
  • Call our office at 920-967-8898 to obtain an application

Priority is given to repairs that are safety risks/code violations and repairs pertaining to the health, safety and well-being of those living in the home.

Contact Us

Barb Jensen
Intake Coordinator
Home Repair Program
921 Midway Road
Menasha, WI 54956
BarbJ@HomeRepairProgram.org