Snow Belt Housing
Home Ownership Assistance Pre-Application
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
County
Postal / Zip Code
How long have you lived at your current address?
Have you ever owned any real property?
Yes
No
Are you able to obtain a mortgage?
Yes
No
Are you willing to complete a homeownership education class?
Yes
No
Tenant info
Names of all household members that contribute to income:
Source of income for each household member:
Total monthly income for each tenant:
What is the total yearly income for everyone in the household?
How many people live in the household?
Is anyone age 60 or over?
Yes
No
Is anyone disabled?
Yes
No
Is anyone handicapped?
Yes
No
Are you a single parent with children aged 18 or younger?
Yes
No
Are you a female head of household?
Yes
No
Have you ever declared bankruptcy?
Yes
No
If yes, when?
Are you current on all debts?
Yes
No
If no, please list debts with monthly payment amount:
Any debts sent to collections?
Yes
No
Do you have any assets?
Yes
No
If yes, please list:
Signature
Clear
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform