June 2017 Pre-Qualification Screening * 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? 18-25 26-39 40-54 55 and above * 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? Yes No * 12. Have you had the same job or source of verifiable income for six months or more? Yes No * 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 * 14. Are you willing to make a cash down payment of $500 towards the purchase of your home? Yes No * 15. Are you willing to live on a lot selected by Habitat for Humanity? Yes No * 16. Are you able and willing to contribute 400 "sweat equity" hours? Yes No * 17. Have you owned a home within the past 3 years? Yes No * 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 Yes No * 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 Submit
