Homeowner Intake Form

Before You Begin: Please Review the Following Eligibility Guidelines

1. Community Commitment and Homeownership Goals
Eureka Oaks is designed for individuals and families who work hard, contribute to the Calaveras County community, and face challenges finding an affordable path to homeownership.

2. Household Income and Financial Readiness
The program is generally intended for households with a combined annual income of approximately $70,000–$80,000. Households with lower incomes may also be considered, particularly those with sufficient savings to contribute toward a down payment and other homeownership expenses.

3. Housing Need and Partnership Commitment
Applicants must demonstrate a need for affordable housing, the financial ability to qualify for and maintain mortgage payments, and a willingness to partner with Habitat for Humanity Calaveras throughout the homeownership process. This partnership includes completing 250 partnership hours as part of the program.
Habitat for Humanity Calaveras Homeownership Program Intake Form for Eureka Oaks Subdivision

Please complete intake form and sign the Authorization to Release Information form.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Potential Applicant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Do you rent or own?
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Age
Are you a veteran?
Which of the following applies?
Income Sources and Amounts (indicate gross monthly income):
Wages
Social Security Income
Child Support
Pension/Retirement/401K
Alimony/Maintenance
Unemployment (seasonally rcvd)
Workers Compensation
SNAP/Public Assistance
Self Employment
Other

Potential Co-Applicant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you rent or own?
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Age
Are you a veteran?
Which of the following applies?
Co-Applicant Income Sources and Amounts (indicate gross monthly income):
Co-Applicant Wages
Co-Applicant Social Security Income
Co-Applicant Pension
Co-Applicant Child Support
Co-Applicant Alimony/Maintenance
Co-Applicant Workers Compensation
Co-Applicant Unemployment (seasonally rcvd)
Co-Applicant SNAP/Public Assistance
Co-Applicant Self Employment
Other

Potential Applicant(s) Debts and Obligations

Rows	Creditor Name	Monthly	Balance
Vehicle Payment
Credit Card
Credit Card
Student Loans
Child Support Owed
Medical Debts
Rent/Mortgage Payment
Other
Other

Rows	Monthly	Balance
If over 62 or a person with a disability Ongoing medical expense (insurance, prescriptions, equipment, etc.)

Assets of all Household Members

Rows	Balance/Value
Cash
Checking Acct
Checking Acct
Savings Acct
Savings Acct
Real Estate Owned
Certificate of Deposit (CD)
Other
Other
Other

Please describe your current housing situation and conditions Include any unsafe or unhealthy living conditions, rent costs exceeding 30% of your income, overcrowded living environment, inadequate utilities etc...
How would you rate your credit?
If you have adverse credit issues, tell me about why it happened and what you have done to correct it:
If you are unsure what your credit history contains, you can obtain a free credit report by calling. 1-877-322-8228 or logging into http://www.annualcreditreport.com. By law, individuals are entitled to receive one free credit file disclosure every 12 months from each of the nationwide consumer credit reporting companies: Equifax, Experian, and TransUnion.
Should be Empty:

Habitat for Humanity Calaveras Homeownership Program Intake Form for Eureka Oaks Subdivision

Potential Applicant Information

Potential Co-Applicant Information

Other Household Members