Neighbors Helping Neighbors
PO Box 286, East Machias, Me
David Grainger, Program Director
Work Application Form
Street Address: _________________________________
Town: _______________________________ State: _____ Zip Code:________________
Type Home: __Mobil/Modular __Frame __Brick __1Story __2 Story __Other Do You Own Home ________
Type of work requested:
Please read the following terms and check each one.
__ I understand the signing this application
does not insure that any or all work will be done.
__ I understand that many of the workers are young people with proper adult supervision.
__ Iunderstand that the work
will be done at no expense to owner unless negotiated prior to beginning such work>
__ I understand that this project can be canceled at anytime by either party.
I understand that the work may require the work of more thatn one crew under the supervision of the Program Director.
__ I understand that the work may not be of the caliber of a professional contractor and work
is not guaranteed.
__ I understand that Down East Maine Missions has the rights to uto related information, pictures and videos .
that the owner or an adult representative be will be available for consultation during the project.
__ I and/or my family meet guidelines for low income assistance. (See below)
(Persons in household 1-$17655- 2-$23895, 3-$230135, 4-$36375 add $6240 for each additional person) Maine LIHEAP guidelines.
Home Owner Signature: ___________________________________Date:____________
NHN Approval Signature:_________________________________
Neighbors Helping Neighbors (NHN) is a program of Down East Maine Missions (DEMM)
Mail to Down East Maine Missions, DEMM, PO Box 286, E Machias, ME 04630 or email to firstname.lastname@example.org
If you email form type your name in the signature block.
To use this form, copy then past to a word document, insert your personal and project info then send via email to email@example.com.