Stillwater Habitat short form housing application
Applicant's information
Full Name
*
First Name
Last Name
Date of birth and Social Security number
*
Date of Birth
Social Security number
Co-applicant
First Name
Last Name
Date of birth and Social Security number of co-applicant
Date of Birth
Social Security number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
First applicant’s phone number
*
Second applicant’s phone number
First applicant’s E-mail
*
example@example.com
Second applicant’s E-mail
example@example.com
Employment for first applicant
*
Name of employer
Position held
Start date and income
*
Start date
Monthly or hourly income
Type of income/child support
*
Full or part-time/numbers of hours per week
Child support
Other income please explain:
Employment for second applicant
Name of employer
Position held
Start date and income
Start date
Monthly or hourly income
Type of income/child support
Full or part-time/numbers of hours per week
Child support
Other income please explain:
Please list everyone in your home, including yourself:
*
Full Name
Age
Male/female
Relationship
1
2
3
4
5
Have you filed for bankruptcy in the last three years?
*
Yes
No
Has the co-applicant filed for bankruptcy in the last three years?
Yes
No
Are you a US citizen or legal permanent resident alien?
*
Yes
No
Is the co-applicant a US citizen or legal permanent resident alien?
Yes
No
Are you both willing to work 200 to 300 hours combined of sweat equity to help build your home?
*
Yes
No
Any other information you think is relevant to your application:
How did you hear about us?
*
Please Select
Newspaper
Website
Facebook
Church
Other
Submit
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