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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, State and Zip (please Include zip code)

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* 7. What is your age range?

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* 8. Household Size(Including You)

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

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

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

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

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* 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.

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

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

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

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

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* 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

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

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* 20. Ethnicity

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* 21. Race

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* 22. Marital Status

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* 23. Are you a Veteran

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

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