Enrollment is easy!  Simply fill out the following forms and either print them off and fax (510) 981-0102 them or send by regular mail.  We must have proof of your income to verify your eligibility for the program.  Therefore, you must include a copy of your tax return, copy of Social Security payments, SSI payment, pension, etc.  Please make sure you complete ALL of the application and submit the proper documents as requested.  If you return an incomplete application, we will resend it to you.  This will delay the process of determining whether you are eligible for services.  If you aren’t eligible, maybe you have friend or relative that is!  Please pass this information on to them so we can start helping them as soon as possible.

Home Safety Repair Program Customer Enrollment Application:
 Home Safety and Repair Enrollment Form 37.72 Kb

 Download Home Safety Repair Re-Enrollment Form 81.49 Kb ( Only for clients who have used our services in the past)

Please fax back to 510-981-0102

-or-

Mail to:
Home Safety Repair Program
1013 Pardee Street, Suite 210
Berkeley, CA 94710

***PLEASE NOTE THAT HOME SAFETY REPAIR WILL SEND OUT APPLICATIONS FOR 2010-2011 JULY 1, 2010***