Habitat for Humanity of Greater Charlottesville
Thank you for your interest in becoming a Habitat Homebuyer. Please complete this online application as the next step in the application process. After submitting your application, you will be contacted by Habitat staff with instructions for next steps. We will accept online applications until August 7, 2026.
APPLICANT INFORMATION MEETING
If you have not already done so, you MUST attend an Applicant Information Meeting (AIM) and take the AIM quiz before submitting the online application below. Your application will not be reviewed until this step is complete.
When did you attend an Applicant Information Meeting (AIM)?
-
Month
-
Day
Year
Date
Applicants must have lived or worked in Habitat Charlottesville's service area for at least the previous 12 months before applying. Our service area includes Charlottesville, Albemarle, Greene, and Louisa. Have you (the applicant) or your co-applicant lived or worked in the service area for at least the previous 12 months?
Yes
No
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Next
SECTION 1: HOUSEHOLD MEMBERS
APPLICANT
Please complete the following section for the primary applicant. This is the person that you wish to be on the title for the home.
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Ethnicity
*
Please Select
Hispanic or Latino
Not Hispanic or Latino
I do not wish to provide this information
Race
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Multi-racial
Native Hawaiian or Pacific Islander
White
Other
I do not wish to provide this information
Gender
*
Please Select
Female
Male
Other
I do not wish to provide this information
Marital status
*
Please Select
Married
Widowed
Separated
Unmarried
Highest level of education
*
Please Select
Elementary School
Middle School
High School/ GED
Associates Degree
Bachelor's Degree
Graduate Degree
Other
CO-APPLICANT
Please complete the following section for the co-applicant. The co-applicant is anyone you wish to also be listed on the title for the home. Legal spouses MUST be listed as co-applicants.
Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Ethnicity
Please Select
Hispanic or Latino
Not Hispanic or Latino
I do not wish to provide this information
Race
Please Select
American Indian or Alaska Native
Asian
Black or African American
Multi-racial
Native Hawaiian or Pacific Islander
White
Other
I do not wish to provide this information
Gender
Please Select
Female
Male
Other
I do not wish to provide this information
Marital status
Please Select
Married
Widowed
Separated
Unmarried
Highest level of education
Please Select
Elementary School
Middle School
High School/ GED
Associates Degree
Bachelor's Degree
Graduate Degree
Other
OTHER HOUSEHOLD MEMBERS
Please list all OTHER persons who would live in the Habitat home if you are approved. You can add additional household members if needed.
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SECTION 2: HOUSING & CONTACT INFORMATION
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
What is the best way to contact you?
*
Please Select
Phone
Email
Mail
Text
Do you need an interpreter?
*
Yes
No
Other
What is your preferred language?
HOUSING INFORMATION
Is your physical address (where you live) the same as your mailing address (where you wish to receive mail)?
*
Yes
No
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your monthly rent?
*
What utilities do you currently pay for (select all that apply)?
*
Electricity
Water/ sewer
Gas
Internet/ cable
Phone plan
N/A - I do not pay for any utilities
RENTAL MANAGEMENT COMPANY INFORMATION
Name of Rental Management Company
Address of Rental Management Company
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Rental Manager
First Name
Last Name
Phone Number of Rental Manager
Please enter a valid phone number.
Format: (000) 000-0000.
Rental History
Have you lived at your current address for AT LEAST the past two years?
Yes
No
Please provide your rental history for the past TWO YEARS
*
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SECTION 3: EMPLOYMENT AND INCOME
Please provide income information for ALL ADULTS in your household (18+ years).
Is the APPLICANT currently employed?
*
Yes
No
Is the APPLICANT currently working in a regular-wage job(s), in which they receive pay stubs?
*
Yes
No
Please provide information on the APPLICANT'S current regular wage job(s)
*
Is the APPLICANT currently working in a self-employed, contracted, or other type of job(s) in which they are paid in cash or checks?
*
Yes
No
Please provide information on the APPLICANT'S current self-employment, contracted, or other type of job(s) in which they are paid in cash or checks
*
Does the APPLICANT receive any additional forms of income (SNAP, SSI, Social Security, etc)?
*
Yes
No
Please list any additional income that the APPLICANT receives
*
Is the CO-APPLICANT currently employed?
*
Yes
No
N/A - no co-applicant
Is the CO-APPLICANT currently working in a regular-wage job(s), in which they receive pay stubs?
*
Yes
No
Please provide information on the CO-APPLICANT'S current regular wage job(s)
*
Is the CO-APPLICANT currently working in a self-employed, contracted, or other type of job(s) in which they are paid in cash or checks?
*
Yes
No
Please provide information on the CO-APPLICANT'S current self-employment, contracted, or other type of job(s) in which they are paid in cash or checks
*
Does the CO-APPLICANT receive any additional forms of income (SNAP, SSI, Social Security, etc)?
*
Yes
No
Please list any additional income that the CO-APPLICANT receives
*
Are any OTHER HOUSEHOLD MEMBERS currently employed?
*
Yes
No
N/A - no other household members
Are any OTHER HOUSEHOLD MEMBERS currently working in a regular-wage job(s), in which they receive pay stubs?
*
Yes
No
Please provide information on the current, regular wage job(s) of your OTHER HOUSEHOLD MEMBERS
*
Are any OTHER HOUSEHOLD MEMBERS currently working in a self-employed, contracted, or other type of job(s) in which they are paid in cash or checks?
*
Yes
No
Please provide information on the current self-employment, contracted, or other type of job(s) of OTHER HOUSEHOLD MEMBERS
*
Do any OTHER HOUSEHOLD MEMBERS receive any additional forms of income (SNAP, SSI, Social Security, etc)?
*
Yes
No
Please list any additional income that OTHER HOUSEHOLD MEMBERS receive
*
SCHOOL ENROLLMENT
Please provide information for anyone enrolled in school (public or private) or a job training program in your household (includes college/ university).
SCHOOL ENROLLMENT INFORMATION
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SECTION 4: PROPERTY & ASSETS
Please provide property/ asset information for ALL ADULTS in your household (18+ years old).
Please list property/ assets owned by the APPLICANT
*
Rows
Does the APPLICANT have this type of account?
Bank Name
Current Balance
Checking Account 1
Yes
No
Checking Account 2
Yes
No
Savings Account 1
Yes
No
Savings Account 2
Yes
No
401K/ Retirement Savings 1
Yes
No
401K/ Retirement Savings 2
Yes
No
Cash on hand at home
Yes
No
Stock/ Bonds
Yes
No
Real Estate
Yes
No
Does the APPLICANT have a vehicle registered in their name?
*
Yes
No
APPLICANT vehicle information
*
Please list property/ assets owned by the CO-APPLICANT
*
Rows
Does the CO-APPLICANT have this type of account?
Bank Name
Current Balance
Checking Account 1
Yes
No
Checking Account 2
Yes
No
Savings Account 1
Yes
No
Savings Account 2
Yes
No
401K/ Retirement Savings 1
Yes
No
401K/ Retirement Savings 2
Yes
No
Cash on hand at home
Yes
No
Stock/ Bonds
Yes
No
Real Estate
Yes
No
Does the CO-APPLICANT have a vehicle registered in their name?
*
Yes
No
CO-APPLICANT vehicle information
*
Do any other household members have property/ assets in their name(s), such as bank accounts, retirement accounts, or real estate?
*
Yes
No
Please list property/ assets owned by OTHER HOUSHOLD MEMBERS.
*
Do any OTHER HOUSEHOLD MEMBERS have a vehicle registered in their name?
*
Yes
No
OTHER HOUSEHOLD MEMBER vehicle information
*
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SECTION 5: DEBT
Please list all companies and persons to which you (APPLICANT) and your CO-APPLICANT (if applicable) owe money. This includes credit cards, car loans, school loans, furniture loans collections, judgments and other types of debt.
*
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SECTION 6: OTHER INFORMATION
Please answer the following questions
*
Rows
Please Select
Are there outstanding judgments against anyone in the household?
Yes
No
Has anyone in the household declared bankruptcy in the past 2 years?
Yes
No
Has anyone had property foreclosed on?
Yes
No
Has anyone in the household been evicted in the past 5 years?
Yes
No
Is anyone in the household involved in a lawsuit?
Yes
No
Is anyone in the household currently delinquent in any loan/ account/ child support?
Yes
No
Is anyone in the household a co-signer on any loan or note?
Yes
No
Has anyone in the household ever been convicted of a misdemeanor?
Yes
No
Has anyone in the household ever been convicted of a felony?
Yes
No
If any answers above are "yes," please explain. A "yes" answer will not automatically disqualify you.
Please answer the following questions
*
Rows
Please Select
Are you or is anyone in your household a member of the U.S. Military?
Yes
No
Is anyone in your household a Veteran of the United States?
Yes
No
Does everyone in your household have health insurance?
Yes
No
If "no," please list the member(s) in your household without health insurance.
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SECTION 7: NEED ASSESSMENT
Please answer the following questions
*
Rows
APPLICANT
How many years?
CO-APPLICANT
How many years ?
Do you currently live or work in Charlottesville, Albemarle, Louisa, or Greene County
Yes
No
Yes
No
N/A
Do you currently live or work in the Fifeville neighborhood?
Yes
No
Yes
No
N/A
Do you currently live or work in the Crozet community?
Yes
No
Yes
No
N/A
Do you currently live in U.S. public housing?
Yes
No
Yes
No
N/A
Do you currently have a U.S. Housing Voucher (Section 8)?
Yes
No
Yes
No
N/A
Do you currently live in another form of U.S. subsidized housing?
Yes
No
Yes
No
N/A
Please answer the following questions
*
Rows
APPLICANT
CO-APPLICANT
Have you been employed at the same job for the past 2 years?
Yes
No
N/A
Yes
No
N/A
Are you currently paying all of your credit cards and loans on time?
Yes
No
N/A
Yes
No
N/A
Please answer the following questions
*
Rows
Please Select
Are you currently homeless (sleeping outside, sleeping in a car, staying in a shelter, staying in a hotel/ motel)?
Yes
No
N/A
Are you currently unstably housed (staying with a family member or friend)?
Yes
No
N/A
Do you currently live in a mobile home or trailer?
Yes
No
N/A
Do you have significant structural safety concerns with your current home? Structural safety concerns might include issues with the foundation, floors, walls, ceiling, and/ or roof that could cause severe injuries.
Yes
No
N/A
Do you have significant health concerns with your current home? Health concerns may include lead paint or asbestos. Health concerns might also include conditions like severe asthma or allergies that are made worse by the home.
Yes
No
N/A
Do you have significant accessibility concerns with your current home? For example, are there essential areas of the home that are hard to access for disabled household members?
Yes
No
N/A
Do you have significant mechanical or utility safety concerns with your current home? These concerns might include broken water pipes, broken electrical wiring, and/ or broken HVAC systems?
Yes
No
N/A
Submit
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