Big Bend Habitat for Humanity
Pre-Qualification Screening

1.First Name(Required.)
2.Last Name(Required.)
3.Email Address(Required.)
4.Phone Number(Required.)
5.Address (please include apartment number)(Required.)
6.City(Required.)
7.State(Required.)
8.Zip Code(Required.)
9.County(Required.)
10.What is your age range?(Required.)
11.Household Size(Including You)(Required.)
12.Number of males in household? (please include ages)(Required.)
13.Number of females in household? (please include ages)(Required.)
14.Have you lived in Leon or Gadsden County for twelve months or more?(Required.)
15.Have you had the same job or source of verifiable income for six months or more?(Required.)
16.Do you have a housing need? Examples include: living in substandard housing conditions, rent payments exceed 30% of your monthly gross income, overcrowded living conditions, or presently living in a transitional housing situation.(Required.)
17.Are you willing to make a cash down payment of $500 towards the purchase of your home?(Required.)
18.Are you willing to live on a lot selected by Habitat for Humanity?(Required.)
19.Are you able and willing to contribute 400 "sweat equity" hours?(Required.)
20.Have you owned a home within the past 3 years?(Required.)
21.Does your household income meet the income criteria below based on household

(Gross income refers to your entire annual household income before taxes)

1 Person: $19,400 - $51,700
2 People: $22,200 - $59,100
3 People: $26,650 - $66,500
4 People: $32,150 - $73,850
5 People: $37,650 - $79,800
6 People: $43,150 - $85,700
7 People: $48,650 - $91,600
8 People: $54,150 - $97,500
22.If yes, please check your household income and write it in the space provided.(Required.)
23.Ethnicity(Required.)
24.Race
25.Marital Status(Required.)
26.Are you a Veteran
27.AFTER YOU SUBMIT THE APPLICATION, YOU WILL RECEIVE A RESPONSE BY MAIL THE FOLLOWING MONTH.