HFHN Homeownership Expression of Interest

Habitat For Humanity Northumberland
764 Division Street, Cobourg ON K9A 5V2

For more info or assistance contact
Ph: 289-252-0999 ext. 36 homeownership@habitatnorthumberland.ca

PLEASE COMPLETE ALL SECTIONS OF THIS EXPRESSION OF INTEREST.

By completing this Expression of Interest application, you are indicating that you are interested in homeownership with Habitat for Humanity Northumberland (HFHN). This form is the first step in the application process. HFHN will review the information you provide to determine if you are eligible to apply for a Habitat home. PLEASE NOTE: If you have met the initial criteria, we require a credit check to continue further in the application process. By submitting this form, you consent to HFHN gathering this information. All information collected is kept confidential.

Name of Applicant*

First NameLast Name

Name of Co-Applicant (if applicable)

First NameLast Name

Current Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Phone Number*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail

Length of time at current Address:*

Are you currently renting your home?*

YesNo

Do you currently own any land?*

YesNo

Have you been a permanent resident of Canada for 1 year or more?*

YesNo

Have you ever filed for bankruptcy?

YesNo

Have you ever filed for consumer proposal?

YesNo

How many ADULTS (over 18 years), including yourself, presently live in your home?*

How many CHILDREN? (please include age and sex - if this doesn't apply, please type N/A in the box below)*

Are you currently employed? (Applicant)

Full-timePart-time

Are you currently employed? (Co-Applicant)

Full-timePart-time

Source of Income:*

Any additional sources of income:

How much do you estimate your total family income per year to be? (Use last year's tax information.)*

How much do you estimate your current monthly expenses to be?

Please explain why your family is interested in applying for a Habitat home.*

I acknowledge that this is a pre-application form and understand that someone from the Housing Partnerships department will contact me within two weeks to further discuss the information shared.

Application Date*