Home Repair Interest

Full Name (First,Last)

Co-Applicant Name (Full Name)

Street Address

City

State

Zip/Postal Code

Phone

Email Address

Are you a US citizen or legal permanent resident? Are you a US citizen or legal permanent resident? Yes No

Are you currently living within our service area? Are you currently living within our service area? Yes No

Are you or a co-applicant a veteran? Are you or a co-applicant a veteran? Yes No

If so, was the veteran honorably discharged? If so, was the veteran honorably discharged? Yes No N/A

Are you willing to partner with Habitat by putting in 350 hours of sweat equity? Are you willing to partner with Habitat by putting in 350 hours of sweat equity? Yes No

If approved, how many people would be living in the home (including yourself)? Please list Name, Year of Birth, and Sex, for each person:

Do you fall within the 30% - 60% income range based on your family size? Do you fall within the 30% - 60% income range based on your family size? Yes No

Have you filed bankruptcy within the last 7 years? If yes, please explain.

Have you ever owned a home (now or in the past)? Have you ever owned a home (now or in the past)? Never owned a home Owned a home in the past Currently own a home

Have you been through foreclosure in the past 20 years? Have you been through foreclosure in the past 20 years? Yes No

List all sources of monthly income, including any from members 18 years and older, who will be residing in the home. List MONTHLY GROSS wages (before taxes and deductions):

Please list your current housing expenses such as rent or utilities: