Connective          


Severe Weather and Derecho Home Repair Application






Confirmation of Identity


Please click here to complete the form.
Please do not fill out this form more than once. If you have questions about an existing application, please email info@connectivetx.org with your name and address.

If you need assistance filling out this application over the phone, please call (713) 903-7564 to speak with a representative in English or Spanish.
Important Information

Thanks for your interest in Connective's Severe Weather and Derecho Home Repair program. The Severe Weather and Derecho Recovery Fund led by the Greater Houston Disaster Alliance, is a joint effort between United Way of Greater Houston and Greater Houston Community Foundation.


Please note that the successful submission of your application is not a guarantee of home repair assistance, and you may be asked to provide additional information at a later date.


Due to limited funding, our non-profit home repair partners will be prioritizing emergency repairs.


Please enter the address of the home that was damaged by the floods, straight line winds, or tornadoes from April 26 – May 17 and needs to be repaired. If you have already filled out a Severe Weather and Derecho Home Repair application for this address, please stop here and email us at info@connectivetx.org for a status update.

Please type your street address and city, and then click on the matching result. Please do not include apartment numbers or unit numbers.












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Connective          


Severe Weather and Derecho Home Repair Application


If you need assistance filling out this application over the phone, please call (713) 903-7564
 to speak with a representative in English or Spanish.
Referral Information








Respondent Information







Primary Household Member Information


We have a phone number listed for you that ends in 



We strongly encourage you to provide your email address or that of a trusted friend or family member. 






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Connective          


Severe Weather and Derecho Home Repair Application


If you need assistance filling out this application over the phone, please call (713) 903-7564
 to speak with a representative in English or Spanish.






Household Demographics

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Connective          


Severe Weather and Derecho Home Repair Application


If you need assistance filling out this application over the phone, please call (713) 903-7564
 to speak with a representative in English or Spanish.
Income Eligibility Information




$
per month
Please enter numbers only and round to the nearest dollar. Commas, decimals, and special characters (such as $) are not allowed.


















Note: If you submit the application without submitting the required documents, Connective will follow up with you to submit them at a later time. The application will not be considered complete until we receive the documents.
Proof of No Income
Acceptable documents are documents demonstrating no income:

Proof of Salary/Wages
Acceptable documents are documents demonstrating income:
  • 2023 signed tax return listing all adult household members
  • 2023 W2(s) for every job held by each adult household member
  • Unemployment compensation statement showing 2023 income
  • Paystubs for the last 30 days
  • Letter from employer verifying monthly salary/wages

Proof of Self-Employment Income
Please complete the following Profit and Loss Ledger and upload it below. If you have your own, you can also submit it below.

Proof of Unemployment Income
Acceptable documents are documents demonstrating unemployment income:
  • Current TWC unemployment check
  • Unemployment compensation statement
  • Letter from employer of termination from employment

Proof of Retirement and/or Pension Income

Proof of Social Security Income

Proof of SSI/Disability Income

Proof of Alimony and/or Child Support Income

Proof of Other Income
If you do not have a document that records your income, please complete the following Declaration of Income Statement and upload it below.

Home Condition

Connective          


Severe Weather and Derecho Home Repair Application


If you need assistance filling out this application over the phone, please call (713) 903-7564
 to speak with a representative in English or Spanish.
Home Damage





We’re sorry but this program is focused on minor repairs and will not be able to reconstruct destroyed homes. We recommend reaching out to 211 and requesting to be connected to a housing counseling agency in your area to discuss your options.

Home Insurance




Wavier

Connective          


Severe Weather and Derecho Home Repair Application



You must acknowledge the above statement and authorize Connective to share your information with other organizations in order to submit this form. 

Are you interested in receiving text notifications about local, free resources and services in our area?
Connective Texts is a free service that sends subscribers 2–3 texts with local resources per week. 

Disclosures:
  • You will receive up to 10 text messages/month from Connective related to nonprofit and government resources.
  • You confirm that you are the subscriber to the relevant phone number or that you are the customary user of that number on a family or business plan and that you are authorized to Opt In.
  • Message & data rates may apply.
  • You can opt-out at any time by replying “STOP” to the text messages you receive.
  • You can adjust my subscription settings by replying "HELP" to the text messages you receive.
  • You will be texted a reminder of instructions for opting out of text messages at least once a month.
  • Your phone number will not be shared with any other organization without your explicit consent.