Pre-Screening Homeownership Questionnaire Question Title * 1. Name of first applicant Question Title * 2. Name of second applicant. If not, please write "N/A." Question Title * 3. Current Address Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Question Title * 4. Current rent/mortgage payment amount Question Title * 5. Are you using Section 8 housing or another housing assistance program? Yes No Question Title * 6. Household Size (include ALL household members that will live in the Habitat home for the majority of the year) Question Title * 7. Estimated total income of ALL working adults (18+) in the household. Question Title * 8. Preference to live in Grand Forks, ND or East Grand Forks, MN Grand Forks, ND East Grand Forks, MN Question Title * 9. Short description of housing need (is your house unaffordable, does it have bad living conditions or is it overcrowded?) Question Title * 10. Are you willing and able to contribute to the mandatory 250 Sweat Equity hours if selected for our program? Yes No Done