Exit June 2017 Pre-Qualification Screening 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, State and Zip (please Include zip code) Question Title * 7. What is your age range? 18-25 26-39 40-54 55 and above Question Title * 8. Household Size(Including You) Question Title * 9. Number of males in household? (please include ages) Question Title * 10. Number of females in household? (please include ages) Question Title * 11. Have you lived in Leon or Gadsden County for twelve months or more? Yes No Question Title * 12. Have you had the same job or source of verifiable income for six months or more? Yes No Question Title * 13. 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. Yes No Question Title * 14. Are you willing to make a cash down payment of $500 towards the purchase of your home? Yes No Question Title * 15. Are you willing to live on a lot selected by Habitat for Humanity? Yes No Question Title * 16. Are you able and willing to contribute 400 "sweat equity" hours? Yes No Question Title * 17. Have you owned a home within the past 3 years? Yes No Question Title * 18. 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: $18,100 - $48,150 2 People: $20,650 - $55,000 3 People: $24,860 - $61,900 4 People: $30,000 - $68,750 5 People: $35,140 - $74,250 6 People: $40,280 - $79,750 7 People: $45,420 - $85,250 8 People: $50,560- $90,750 Yes No Question Title * 19. If yes, please check your household income and write it in the space provided. Annual Income Monthly Income Bi-Weekly Income Weekly Income Write Income Amount Question Title * 20. Ethnicity Hispanic or Latino Not Hispanic or Latino Mexican Puerto Rican Cuban Question Title * 21. Race American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Question Title * 22. Marital Status Married Single Widowed Separated Question Title * 23. Are you a Veteran Yes No Question Title * 24. AFTER YOU SUBMIT THE APPLICATION, YOU WILL RECEIVE A RESPONSE BY MAIL THE FOLLOWING MONTH. Submit