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Big Bend Habitat for Humanity
Pre-Qualification Screening
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Email Address
(Required.)
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4.
Phone Number
(Required.)
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5.
Address
(please include apartment number)
(Required.)
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6.
City
(Required.)
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7.
State
(Required.)
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8.
Zip Code
(Required.)
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9.
County
(Required.)
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10.
What is your age range?
(Required.)
18-25
26-39
40-54
55 and above
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11.
Household Size(Including You)
(Required.)
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12.
Number of males in household?
(please include ages)
(Required.)
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13.
Number of females in household?
(
please include ages)
(Required.)
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14.
Have you lived in Leon or Gadsden County for twelve months or more?
(Required.)
Yes
No
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15.
Have you had the same job or source of verifiable income for six months or more?
(Required.)
Yes
No
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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.)
Yes
No
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17.
Are you willing to make a cash down payment of $500 towards the purchase of your home?
(Required.)
Yes
No
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18.
Are you willing to live on a lot selected by Habitat for Humanity?
(Required.)
Yes
No
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19.
Are you able and willing to contribute 400 "sweat equity" hours?
(Required.)
Yes
No
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20.
Have you owned a home within the past 3 years?
(Required.)
Yes
No
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
Yes
No
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22.
If yes, please check your household income and write it in the space provided.
(Required.)
Annual Income
Monthly Income
Bi-Weekly Income
Weekly Income
Write Income Amount
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23.
Ethnicity
(Required.)
Hispanic or Latino
Not Hispanic or Latino
Mexican
Puerto Rican
Cuban
24.
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
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25.
Marital Status
(Required.)
Married
Single
Widowed
Separated
26.
Are you a Veteran
Yes
No
27.
AFTER YOU SUBMIT THE APPLICATION, YOU WILL RECEIVE A RESPONSE BY MAIL THE FOLLOWING MONTH.