* 1. First Name

* 2. Last Name

* 3. Email Address

* 4. Phone Number

* 5. Address

* 6. City, State and Zip

* 7. What is your age range?

* 8. Household Size(Including You)

* 9. Number of males in household and ages?

* 10. Number of females in household and ages?

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

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

* 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.

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

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

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

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

* 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: $14,350 - $38,300
2 People: $16,400 - $43,800
3 People: $20,420 - $49,250
4 People: $24,600 - $54,700
5 People: $28,780 - $59,100
6 People: $32,960 - $63,500
7 People: $37,140 - $67,850
8 People: $41,320 - $72,250

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

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