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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Phone Number

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* 5. Address (please include apartment number)

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* 6. City

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* 7. State

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* 8. Zip Code

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* 9. County

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* 10. What is your age range?

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* 11. Household Size(Including You)

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* 12. Number of males in household? (please include ages)

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* 13. Number of females in household? (please include ages)

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* 14. Have you lived in Leon or Gadsden County for twelve months or more?

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* 15. Have you had the same job or source of verifiable income for six months or more?

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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.

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* 17. Are you willing to make a cash down payment of $500 towards the purchase of your home?

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* 18. Are you willing to live on a lot selected by Habitat for Humanity?

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* 19. Are you able and willing to contribute 400 "sweat equity" hours?

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* 20. Have you owned a home within the past 3 years?

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* 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: $18,650 - $49,700
2 People: $21,300 - $56,800
3 People: $25,820 - $63,900
4 People: $31,200 - $70,950
5 People: $36,580 - $76,650
6 People: $41,960 - $82,350
7 People: $47,340 - $88,000
8 People: $52,720- $93,700

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* 22. If yes, please check your household income and write it in the space provided.

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* 23. Ethnicity

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* 24. Race

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* 25. Marital Status

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* 26. Are you a Veteran

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* 27. AFTER YOU SUBMIT THE APPLICATION, YOU WILL RECEIVE A RESPONSE BY MAIL THE FOLLOWING MONTH.  

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