Work Project Request

CHURCH MOUSE INTAKE IS TUESDAYS 1:00-4:00 AND PICK-UP IS WEDNESDAYS 1:00-4:00

God's Country Community Ministries

Work Project Request

First name

Last name

Phone

Do you have a landline phone we can use? If so, please enter it here.

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Do you receive Medicaid?

Yes

Do you receive Food Stamps?

Yes

Are you disabled?

Yes

Do you own the property where this work will be performed?

Yes

Parking available for how many vehicles?

Is there room for a 15 passenger van?

Yes

The following questions do not influence our decision as to whether the project will be done. They simply help us in the planning of how many projects can be done as we are on a limited budget.

Can you provide any of the materials required for this project?

All

Partial

None

If Partial, please complete the section at the end of the application to indicate what you can provide.

Can you provide any labor to help with the project?

Yes

If yes, how many hours can you work each day and do you have any limitations?

Can you provide any funds to help defer the cost of this project?

Yes

If yes, please indicate an approximate range of funds.

Resident Agreement - Please read and initial all items. By entering an electronic resident's signature, I understand and agree that:

Signing this agreement does not guarantee than any work will be done.

I am a resident of this home that I am requesting work done on.

The mission team volunteers are allowed to perform repairs and improvements on my house.

Some volunteers may be young people working with adult supervision.

Any or all projects can be cancelled at any time.

Work selected depends on budget, skill level, and time available.

Work teams will attempt to finish any work that they have begun, but any work not yet begun during the work week may be considered cancelled.

The Volunteers are NOT professional contractors and work is NOT guaranteed.

I give permission for my or my project's picture to be taken and/or story to be shared or published.

I understand that I am required to be home during the week that the team is working at my home.

Resident's Signature

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Has GCCM worked on your home before? If so, what date was the work done and what type of work was performed?

Work Type: Rank the work to be done in the order you would like to have it completed (if we are able) with 1 indicating the most important.

Drywall

Exterior Paint

Gutters/Fascia/Soffits

Interior Paint

Porch

Roof

Siding

Skirting

Steps

Wheelchair ramp

Other

*Please note: We may not be able to complete all of the work you have requested.

Description of Work Project(s) (List each project separately and in order of priority).

What materials are needed to complete these projects?

General Work Policies

All work on client's homes has to be approved by committee.
You MUST reside in the home you are requesting work done on.
You MUST be a full-time resident of the Upper Peninsula.
We do NOT work on homes that are for sale.
We can do work on land contracts but the land contract MUST be filed in the courthouse. A copy of the land contract must be submitted.
Work is prioritized by the need of the clients.
We reserve the right to refuse work on any home.
No drugs or alcohol allowed on work site.
ONE APPLICATION PER YEAR. YOU MUST REAPPLY EVERY YEAR.
All pets MUST be RESTRAINED.

PURPOSE STATEMENT

"The mission of God's Country Community Ministries is to bring together people of all churches to provide mutual love and support for a greater impact serving Christ, community and mission to all."

APPLICATIONS WILL NOT BE ACCEPTED AFTER APRIL 30

Please submit this application electronically or return to:

GCCM Dunlap Center

ATTN: Loren McFadden

PO Box 141

6545 S M-123

Newberry, MI 49868

I understand and have read the General Work Policies.

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