Pre-Qualifying Questionnaire
Thank you for your interest in applying to our Homeownership Program. Please fill out each field below to the best of your ability.
General Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Co- Applicant Name
First Name
Last Name
Co- Applicant Date of Birth
-
Month
-
Day
Year
Date
Co- Applicant Email
example@example.com
Co-Applicant Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Co-Applicant Phone Number
Please enter a valid phone number.
Are you (and Co-Applicant) a U.S. citizen or legal permanent resident?
*
Please Select
Yes
No
Do you live in public housing?
*
Please Select
Yes
No
Do you receive a section 8 voucher?
*
Please Select
Yes
No
Are you a veteran of the armed forces?
*
Please Select
Yes
No
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Need for Housing
I have owned a home in the last 3 years
*
Please Select
Yes
No
I have foreclosed on a home in the last 3 years
*
Please Select
Yes
No
My current housing is inadequate and/or the conditions are substandard
*
Please Select
Yes
No
I have been a resident of Hamilton County for at least 12 months
*
Please Select
Yes
No
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Ability to Pay
I have had a steady income in the U.S. for at least 2 years
*
Please Select
Yes
No
I have $2,000 or more in Collections, Judgements and/or Charge offs on my credit report.
*
Please Select
Yes
No
I have declared bankruptcy and/or been discharged from bankruptcy in the within the last 2 years
*
Please Select
Yes
No
I am able to make regular monthly deposits into an authorized savings account for closing costs.
*
Please Select
Yes
No
Please list ALL sources of income including Employment, Families First/TANF, Child Support, Social Sec., and/or Disability for Applicant, Co-Applicant and anyone in your household age 18+.
*
Employer's Name
Gross Monthly Amount (before taxes)
Type of Income
Income Source 1
Employment
Families First/TANF
Child Support
Social Security
Disability
Income Source 2
Employment
Families First/TANF
Child Support
Social Security
Disability
Income Source 3
Employment
Families First/TANF
Child Support
Social Security
Disability
Income Source 4
Employment
Families First/TANF
Child Support
Social Security
Disability
Income Source 5
Employment
Families First/TANF
Child Support
Social Security
Disability
Income Source 6
Employment
Families First/TANF
Child Support
Social Security
Disability
Total Monthly Income for Entire Household
*
Before taxes and deducations
Number of individuals in household
*
Please Select
1
2
3
4
5
6
7
8+
I meet the required income guidelines for my household size, based upon the above chart.
Please Select
Yes
No
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Willingness to Partner
I am willing to partner with Habitat by contributing the minimum required "sweat equity" hours: 200 hours for applicants with disabilities, 300 for singles, and 400 for couples (applicant and co-applicant)
*
Please Select
Yes
No
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Certify and Submit
By signing and submitting this Questionnaire, I/we request consideration for Habitat for Humanity of Greater Chattanooga's homeownership program. I understand my/our credit report will be used to help determine my/our eligibility.
Application Signature
*
Co-Application Signature
RELEASE: By signing and submitting this Questionnaire, I/we request consideration for Habitat for Humanity of Greater Chattanooga’s homeownership program and consent to receiving email correspondence regarding my application.
We do not discriminate on the basis of race, sex, color, age, disability, religion, national origin, familial status, marital status, or because all or part of income is derived from any public assistance program.
APPROVED/DENIED HIDDEN
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