Fairmont Preapplication Form
Contact Information
Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Are you a full-time resident or employed in Marion County?
*
Yes
No
Partnership Section
Are you willing to partner with Habitat by providing sweat equity (working on your home or another Habitat home), responding to requests for information, etc.?
Yes
No
Do you have the ability to take on the responsibility for an affordable 20-30 year mortgage?
Yes
No
Do you have the ability to make an affordable monthly on-time mortgage payment?
Yes
No
Do you have a need for housing?
Yes
No
Income Information
How many total people live in the household?
Is your total income between $31,400 and $37,680?
Yes
No
Is your total income between $35,900 and 43,080?
Yes
No
Is your total income between $40,400 and $48,480?
Yes
No
Is your total income between $44,850 and $53,820?
Yes
No
Is your total income between $48,450 and $58,140?
Yes
No
Is your total income between $52,050 and $62,460?
Yes
No
Is your total income between $55,650 and $66,780?
Yes
No
Is your total income between $59,250 and $71,100?
Yes
No
Are you applying with a co-applicant?
Yes
No
Name of co-applicant
First Name
Last Name
Birthdate of co-applicant
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you (and co-applicant) a US citizen or legal permanent resident?
Yes
No
Do you have a current source of income?
Yes
No
Source of income?
How often is your income received?
Weekly
Bi-weekly
Monlthy
Gross amount before taxes?
Add a 2nd source of income?
Yes
No
2nd source of income?
How often is your income received?
Weekly
Bi-weekly
Monlthy
Gross amount before taxes?
Add a 3rd source of income?
Yes
No
3rd source of income?
How often is your income received?
Weekly
Bi-weekly
Monlthy
Gross amount before taxes?
Add a 4th source of income?
Yes
No
4th source of income?
How often is your income received?
Weekly
Bi-weekly
Monlthy
Gross amount before taxes?
Additional Household Residents
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
By checking this box, I affirm that the above information is true. I understand that providing false information could cause me to not qualify to purchase a Habitat home. I authorize Mon Valley Habitat for Humanity to obtain my credit report.
Submit
Should be Empty: