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 Question Title * 6. City, State and Zip 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 and ages? Question Title * 10. Number of females in household and 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: $14,500 - $38,600 2 People: $16,910 - $44,100 3 People: $21,330 - $49,600 4 People: $25,750 - $55,100 5 People: $30,170 - $59,550 6 People: $34,590- $63,950 7 People: $39,010 - $68,350 8 People: $43,430 - $72,750 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. Race/National Origin Black/African American Caucasian Hispanic American-Indian Asian Other Question Title * 21. Marital Status Married Single Widowed Separated Question Title * 22. Are you a Veteran Yes No Submit