MOWCTX Home Repair — Water Filtration Application (Veteran)

TEST MODE — please do not submit real documents yet.

Recent testing found elevated lead in the drinking water in the [Austin's Colony] area. If you are a veteran homeowner in the affected area, Meals on Wheels Central Texas may install a certified water filtration system — and address other home repairs — at no cost to you, through The Home Depot Foundation. Complete this short application and upload the required documents.

First, a few quick questions

Are you a U.S. military veteran with an honorable discharge?

YesNo

Do you own and live in the home as your primary residence?

YesNo

Is your home in the affected water area (Austin's Colony / [affected area])?

YesNo

1 · Applicant

The veteran homeowner applying.

Full name

Date of birth

Primary phone

Secondary phone

Primary (home) address

City

ZIP

This program currently serves ZIP 78725.

Mailing address (if different)

2 · Co-applicant (optional)

Full name

Date of birth

Primary phone

3 · Household & income

List everyone living in the home. Income is required for all members age 18+.

Number of people in the household

Name	Date of birth	Gross monthly income (18+)

4 · What repairs do you need?

Water filtration is the focus of this outreach, but you may request other repairs too.

Please describe your needs

Electric service provider

Gas service provider (if any)

5 · Required documents

Upload a photo or PDF of each. Required by The Home Depot Foundation.

Government-issued photo ID — applicant

TX driver's license or state ID

Government-issued photo ID — co-applicant

If a co-applicant is listed

Proof of honorable discharge — DD‑214

Member copy showing character of service

Most current mortgage statement

Or proof of home ownership (deed / tax statement) if no mortgage

Household income documentation

For all members 18+ (pay stub, benefit/SSA letter, pension, etc.)

The photo/media release is included in this form (Section 7) — no separate upload needed.

6 · Demographics (optional — for grant reporting)

Race (select all that apply)

American Indian / Alaska Native Asian Black / African American Native Hawaiian / Pacific Islander White Prefer not to answer

Ethnicity

Gender

Marital status

7 · Certification, photo release & signature

I certify that the information provided is true and complete, and I authorize Meals on Wheels Central Texas to review my application and contact me about home repair services.

Photo / Media Release. I grant Meals on Wheels Central Texas and The Home Depot Foundation permission to photograph and video me and my home before, during, and after the work, and to use those images for documentation, reporting, and promotional purposes. Read full release.

Your signature below applies to both the certification and the photo/media release above.

Printed name

Date

Signature

Sign above with your finger or mouse