HERITAGE BUILDING SUBMISSION & ASSESSMENT FORM

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HERITAGE BUILDING SUBMISSION & ASSESSMENT FORM

This is the form funders love because it proves:

real buildings exist
projects are ready
money can be deployed responsibly

You can copy-paste this directly into Wix Forms.

HERITAGE BUILDING SUBMISSION FORM

Historic & Rural Structure Repair Consideration

1. Contact Information

Full Name
Email Address
Phone / WhatsApp
Country of Residence

2. Relationship to the Building

Your relationship to the building☐ Owner☐ Family member☐ Caretaker☐ Community representative☐ Other (please explain)
Do you have permission to submit this building for consideration?☐ Yes☐ No☐ In progress

3. Building Location

Country
Region / Voivodeship
Town / Village
Approximate address or description of location

4. Building Information

Estimated age of the building☐ Pre-1900☐ 1900–1945☐ 1945–1970☐ Unknown
Type of structure☐ Residential home☐ Farmhouse☐ Agricultural building☐ Mixed-use☐ Other
Primary construction materials☐ Stone☐ Timber☐ Brick☐ Mixed / Traditional methods

5. Current Condition

Overall condition☐ Stable☐ Deteriorating☐ At risk☐ Urgent intervention needed
Known issues (select all that apply)☐ Roof damage☐ Structural concerns☐ Moisture / damp☐ Masonry deterioration☐ Timber decay☐ Foundation issues☐ General neglect

6. Urgency & Risk

Is the building currently inhabited?☐ Yes☐ No☐ Partially
Risk of loss within the next 1–3 years☐ Low☐ Moderate☐ High

7. Cultural & Historical Significance

Why is this building important to preserve?(family history, regional architecture, craft traditions, land use, etc.)
Any known historical documentation or stories associated with it?

8. Previous Work or Interventions

Has any restoration or repair work been done previously?☐ Yes☐ No☐ Unknown
If yes, briefly describe

9. Desired Support

What type of support are you seeking?☐ Assessment & documentation☐ Stabilization / emergency repair☐ Long-term restoration planning☐ Guidance on preservation methods☐ Grant alignment / funding pathways

10. Photo Uploads

(Enable file upload in Wix)

Exterior photos
Interior photos (if safe)
Detail photos (roof, walls, beams, damage)

11. Acknowledgement

☐ I understand that submission does not guarantee funding or selection☐ I agree to provide accurate information to the best of my knowledge☐ I understand this project prioritizes repair, stewardship, and long-term use

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