Please do not fill out this form more than once. If you have questions about an existing application, please email [email protected] with your name and address.

If you need assistance filling out this application over the phone, please call (713) 862-8222 for speak with a representative in English or Spanish.
Important Information

Thanks for your interest in Connective's 2021 Winter Storm home repair program. This program is funded by the Houston-Harris County Winter Storm Relief Fund and Fort Bend Recovers.

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 the following repair items:

  • Muck & gut/removal of damaged interior building materials
  • Proper preventative dry-out & water extraction of leak affected area
  • Plumbing repairs:
    • Achieve running water with no leaks
    • Replace essential fixtures (kitchen sink, toilet, shower/tub, hot water heater) if necessary
    • Interior water service only
    • Insulation of new pipes

Please enter the address of the home that was damaged by the 2021 Winter Storm and needs to be repaired. If you have already filled out a 2021 Winter Storm Home Repair application for this address, please stop here and email us at [email protected] for a status update.

Type your address and click on the matching result.











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If you need assistance filling out this application over the phone, please call (713) 862-8222 to speak with a representative in English or Spanish.
Respondent Information



















Primary Contact or Homeowner's Information








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If you need assistance filling out this application over the phone, please call (713) 862-8222 to speak with a representative in English or Spanish.
Household Demographics and Income



By age group, please account for all household members currently living with you at the home, including yourself.

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If you need assistance filling out this application over the phone, please call (713) 862-8222 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:
  • 2019 or 2020 tax return listing all adult household members
  • 2020 W2(s) for every job held by each adult household member
  • Unemployment compensation statement showing 2020 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 and Ownership











Wavier



Connective Texts


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