Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Email Address

Question Title

* 4. Phone Number

Question Title

* 5. Address (please include apartment number)

Question Title

* 6. City

Question Title

* 7. State

Question Title

* 8. Zip Code

Question Title

* 9. County

Question Title

* 10. What is your age range?

Question Title

* 11. Household Size(Including You)

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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.

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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

Question Title

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

Question Title

* 23. Ethnicity

Question Title

* 24. Race

Question Title

* 25. Marital Status

Question Title

* 26. Are you a Veteran

Question Title

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

T