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Release Date: August 30, 2011

Received the following advisory from Habitat for Humanity. Some families may qualify for assistance from Habitat--especially after the hurricane. PAUL FEINER
Brush With Kindness is a volunteer neighborhood program, run by Habitat for Humanity of Westchester, offering light exterior home renovation to low-income homeowners who need help to complete the work.  These projects are undertaken throughout the summer, within Westchester County.  Exterior painting is the main task to be completed by volunteers.  Landscaping, clean-up and minor repairs (excluding roof repairs) may be done depending on the skills and the size of the volunteer team.

Please fill out the application completely, and return it to:

A Brush With Kindness Program, 524 Main Street, New Rochelle, NY 10801



Name of Homeowner(s)____________________________________________________________

Address: ________________________________________________________________________

City: _________________________________________State:_______ Zip Code:_______________

Phone Number(s): Home: ___________________________ Work:  __________________________

List all others living at this address and their ages:

Name: ___________________________________________________________ Age: ___________

Name: ___________________________________________________________Age: ____________

Name: ___________________________________________________________ Age: ___________

Name: ___________________________________________________________ Age: ___________


It is important that our volunteers have use of bathroom facilities.  Will your bathroom facilities be available to volunteers?   Yes______  No _____

If your home is chosen, will you be willing to be interviewed or have your picture taken by the media?  Yes_____  No _____

Sign name for approval: _____________________________________________________________

HOUSE INFORMATION:           Circle the size of your home:

1 story 1.5 story 2 story 2.5 story 3 story

Type of material on house (wood, stucco, aluminum, brick, shakes, etc.)

House Siding __________________________  Trim _________________________

Garage Siding _________________________ Trim _________________________


Circle parts of home that need painting: Check garage size:

House Siding 1 stall __________

Garage Siding 2 stall __________

House Trim 3 stall __________

Garage Trim no garage _______

Other - Fence / Deck / Shed __________________________________________________________

Please list and describe all other outside work that you would like done (except roof repair):





SPECIAL NEEDS/  pumping out water/ debris removal etc....

Does anyone in your home have special needs?

Please describe: ___________________________________________________________________


Are there any other special family circumstances we should consider?



Please indicate the income of all persons living in the home.

Combined annual income from salaries, public assistance, pension, social security, rental income, etc all info confidential__________________________________________________________________

Please list all the adults living in your house.


HOMEOWNER AGREEMENT:  I certify that the information on this application is correct to the best of my knowledge.  I have no plans of moving or selling my property in the next two years.  I confirm that my home is a safe place for volunteers to work.  I understand that all physically able persons living in my home or visiting during the time that volunteers are working on my home will be expected to work alongside A Brush With Kindness volunteers.  I also understand that the people who work on my home are volunteers and that A Brush With Kindness makes no warranties, expressed or implied, regarding any materials used or work done by anyone at my house.

I accept and agree to the stated provisions of this program and release A Brush With Kindness, Habitat For Humanity of Westchester, Inc., and all associated with it from any and all liability.

_______________________________________________   ______________________

Homeowner Signature       Date

All potential homes must be tested for the presence of lead based paint. One of our staff will perform a minor test when they inspect your home.  Please sign below to give your approval for this test.

________________________________________________  ______________________

Homeowner Signature       Date

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