Application to have your House Painted
Project Paint will be June 11, 2005. If you would like your home considered for Project Paint,
please complete this application and bring, mail or fax to Fairbanks NHS. Call us at 451-7230 if
you have any questions.
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Anyone may nominate their own or another’s home to be painted.
Volunteers paint the homes with donated materials.
Fairbanks Neighborhood Housing Services coordinates the program..
Eligibility Requirements
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The home MUST be in NEED of paint.
The owner occupant of the home must 1) be financially unable to afford a commercial paint job;
and 2) meet income eligibility requirements based upon area median income unless the owner
occupant falls into one of the following categories: (a) 55 years of age or older, (b) single head of
household, (c) individual who experiences a disability, or (d) experiencing an economic hardship.
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 If the home is not owner occupied, the owner must meet income eligibility requirements based
upon area median income and will be charged a painting fee.
Fairbanks NHS and the Project Paint Committee select the homes to be painted. Particular
attention will be paid to the financial need of the applicant and condition of the house. All decisions
are final. If your home is not selected this year, please re-submit your application next year.
Please turn over to apply.
Application
Homeowner(s): ___________________________________ Date of Birth: ________________
Address: _____________________ City: _____________ State: ____ Zip Code: _______
Phone (Day): _________________________ (Evening) _______________________
(Please check all that apply) Are you a: __ Homeowner
__ Disabled __ Senior Citizen (55 or older)
__ Single Head of Household
__ Experiencing an Economic Hardship
Number of Household Members _____ Age of Dependent(s) _______________
Household’s Gross Monthly Income and Expenses:
Salary: __________________ Food: __________ Clothing: ____________
Social Security/Disability: _______________ Utilities: _________________
Retirement: _______________ Medical: ___________________________
Other Income: _____________ Entertainment/Other: _________________
House Payment: ___________
How did you hear about Project Paint? ______________________________
Only Houses 1 (one) to 1 ½ (one and one-half) Stories Qualify:
My home is: __ 1 (one story) __ 1 ½ (one and one-half stories)
The part of my home that needs painting: __ Trim __ House ___Both Trim and House
I think scraping is required: __ Frame siding __ Trim
Other (please specify): ___________________________________________
My home is: __ Wood Siding __ Aluminum Siding __ Stucco Siding
__ Mobile Home
Do you have: __ Detached Garage __ Wooden Fence
If your home is selected:
 You will be notified by Fairbanks NHS.
 Someone from Fairbanks NHS will contact you to select paint colors from a color chart.
 Someone from your household must be present on the day of the event, June 10, 2000!
 Can you supply ladders? Yes _____ No _____ How Many _____
 Can you provide soft drinks or coffee for the volunteers? Yes _____ No _____
 Can you provide restroom facilities? Yes _____ No ______
 List of names & telephone numbers of friends/relatives who will help paint.
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To the best of my knowledge this information is correct. I understand my home is being painted by
volunteers, and I will not hold Fairbanks NHS, sponsoring agencies, or volunteers liable.
Signature: ______________________________ Date: __________________