APPLICATION FOR HOUSING

APPLICATIONS ARE CLOSED FOR YEAR 2018. PLEASE KEEP UPDATED WITH US AND COME TO OUR REQUIRED INFORMAITONAL MEETING FOR YEAR 2019.

If you have any questions, call the main office at (801) 475-9821. If you need more space, use separate pieces of paper and attach them to this application. All information on this application will be kept confidential. We may ask that you submit additional papers, such as tax returns, proof of income, proof of public assistance, etc. If there is only 1 applicant on the form, please answer N/A to the Co-Applicant questions. The Co-Applicant is someone who will share ownership of the home, responsibility for the mortgage, and who will also live in the Habitat home.

Habitat for Humanity of Weber and Davis Counties

859 West Hill Field Road Layton, UT 84041 | info@habitatwd.org | 801-475-9821

Enclose copies of the following documents (DO NOT SEND ORIGINALS) with the application. You may upload your copies or email your copies to info@habitatwd.org or mail your copies to the main office:

Your preivous year or current income tax return. If you did not file taxes for the previous or current year, please provide a letter, signed by you, that states you did not file taxes and the reason why.
Your last 2 paycheck stubs or other proof of income
Your last 2 bank statements showing all checking, savings, and loan balances. If you do not have a bank account, please write that on your application
Proof of child support and/or public assistance (Such as SSI, TANF, Social Security, disability, food stamps, etc) if you receive them.
Proof of home ownership (this may include recent property tax receipt or Deed of Trust). This is if you own a home.

Upload the important documents {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

1. APPLICATION INFORMATION

APPLICANT #1

NAME (FIRST, MIDDLE, LAST) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SOCIAL SECURITY NUMBER {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HOME PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CELL PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WORK PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MARITAL STATUS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT

NAME (FIRST, MIDDLE, LAST) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SOCIAL SECURITY NUMBER {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HOME PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CELL PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WORK PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MARITAL STATUS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS

List everyone (other than applicant and co-applicant) who will live in your home. Please include what relationship the household member has to the applicant (i.e., daughter, son, mother, father, uncle, aunt, etc.)

You may include children you are expecting.

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DATE OF BIRTH {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RELATIONSHIP {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOES THIS PERSON RECEIVE INCOME? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

2. HOUSING HISTORY

APPLICANT #1

Is your current address the same as Co-Applicant {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MAILING ADDRESS, IF DIFFERENT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YOU CURRENTLY OWN YOUR RESIDENCE

What is your monthly payment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

What is your unpaid balance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YOU RENT YOUR RESIDENCE

Please attach a copy of lease or copy of a money order receipt or canceled rent check. If this does not apply to you, skip this section.

Upload copies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

What is your monthly payment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CURRENT LANDLORD'S NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

FORMER ADDRESSES FOR PAST 2 YEARS

Were your former addresses for the past 2 years the same as Co-Applicant? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT

Is your current address the same as Applicant #1 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MAILING ADDRESS, IF DIFFERENT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YOU CURRENTLY OWN YOUR RESIDENCE

What is your monthly payment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

What is your unpaid balance? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YOU RENT YOUR RESIDENCE

Please attach a copy of lease or copy of a money order receipt or canceled rent check. If this does not apply to you, skip this section.

Upload copies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

What is your monthly payment? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CURRENT LANDLORD'S NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

FORMER ADDRESSES FOR PAST 2 YEARS

Were your former addresses for the past 2 years the same as Applicant #1? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

MOVE IN DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CONDITION OF YOUR CURRENT LIVING PLACE

IF OTHER, PLEASE EXPLAIN: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

OTHER ROOMS IN THE PLACE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Does your home have any problems that you consider to be hazardous to your health or safety (mold, bugs, electrical problems, broken stairs, etc.)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are your home’s mechanical and weather-proofing systems functioning properly (plumbing, heating/cooling, refrigeration, roofing, windows, etc)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you or a family member have accessibility needs that are not met by your current house (handrails, ramps, wider doors, and other aids)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WHY DO YOU NEED A HABITAT HOME?

In the space below, describe the condition of and problems with your current housing (please be specific and thorough by providing all information you think we should know about your current housing). {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

If you are approved for a Habitat Home, how should your name(s) appear on legal documents? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

3. EMPLOYMENT HISTORY

Beginning with your current employment, tell us about your recent 5 years of work history.

If you need more space, please attach another piece of paper with the information.

APPLICANT #1

CURRENT EMPLOYER

ARE YOU UNEMPLOYED? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SECONDARY EMPLOYER

DO YOU HAVE A SECOND JOB? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PREVIOUS EMPLOYERS

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

END DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PREVIOUS EMPLOYERS

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

END DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YOU HAD PREVIOUS EMPLOYERS NOT LISTED ABOVE, PLEASE ATTACH A DOCUMENT WITH THE INFORMATION NEEDED ABOVE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

CO-APPLICANT

CURRENT EMPLOYER

ARE YOU UNEMPLOYED? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SECONDARY EMPLOYER

DO YOU HAVE A SECOND JOB? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PREVIOUS EMPLOYERS

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

END DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PREVIOUS EMPLOYERS

COMPANY NAME {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS SELF-EMPLOYMENT OR CONTRACT WORK? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

POSITION HELD {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ADDRESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TYPE OF BUSINESS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME OF SUPERVISOR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BUSINESS PHONE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HIRE DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

END DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RATE OF PAY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YOU HAD PREVIOUS EMPLOYERS NOT LISTED ABOVE, PLEASE ATTACH A DOCUMENT WITH THE INFORMATION NEEDED ABOVE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

4. MONTHLY HOUSEHOLD INCOME AND RESOURCES

Please indicate monthly amounts that the applicants or anyone in the household receives for the type of income below. It is extremely important to disclose and document all household income. Under certain circumstances, we may not have to count certain sources of income, but we need to be aware of it. Our income limits are strict due to the nature of our program and funding sources.

Therefore, if undeclared income is discovered, application will be denied.

JOBS-BASE SALARY, EARNINGS (BEFORE TAXES AND DEDUCTIONS)

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ARE ANY OF THESE HOUSEHOLD MEMBERS WHO EARN INCOME ALSO ENROLLED AS FULL-TIME STUDENTS? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YES, WHO? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

JOBS-OVERTIME, BONUSES, COMMISSIONS

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

EXPLAIN {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

UNEMPLOYMENT

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WHEN DID THIS INCOME BEGIN? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PENSION

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WHEN DID THIS INCOME BEGIN? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CHILD SUPPORT

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS COURT-ORDERED? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ALIMONY

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IS THIS COURT-ORDERED? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SOCIAL SECURITY

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WHEN DID THIS INCOME BEGIN? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SSI

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WHEN DID THIS INCOME BEGIN? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DISABILITY

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WHEN DID THIS INCOME BEGIN? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

TANF/FAMILIES FIRST/AFDC

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WHEN DID THIS INCOME BEGIN? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

FOOD STAMPS

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NEXT RECERTIFICATION DATE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

REGULAR FINANCIAL SUPPORT FROM OTHERS

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

EXPLAIN {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

OTHER

APPLICANT #1 $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CO-APPLICANT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OTHER HOUSEHOLD MEMBERS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

EXPLAIN {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

5. CHECKING, SAVINGS, AND OTHER ACCOUNTS

ACCOUNT #1

NAME OF BANK OR FINANCIAL INSTITUTION {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ACCOUNT # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BALANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME(S) ON ACCOUNT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

ACCOUNT #2

NAME OF BANK OR FINANCIAL INSTITUTION {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ACCOUNT # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BALANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME(S) ON ACCOUNT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

ACCOUNT #3

NAME OF BANK OR FINANCIAL INSTITUTION {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ACCOUNT # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BALANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME(S) ON ACCOUNT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

ACCOUNT #4

NAME OF BANK OR FINANCIAL INSTITUTION {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ACCOUNT # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

BALANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NAME(S) ON ACCOUNT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

6. OTHER ASSETS

Answer the following regarding valuable assets that you or the co-applicant own.

DO YOU CURRENTLY OWN HOME, LAND, OR PROPERTY? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IF YES, WHAT IS THE MONTHLY PAYMENT? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DO YOU OWN A: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DO YOU OWN A: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DO YOU OWN AUTOMOBILES? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

LIST EACH VEHICLE WITH YEAR, MAKE, AND MODEL (i.e. 1999 Toyota Camry) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

APPLICANT #1 DRIVER'S LICENCE (Number and State) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

CO-APPLICANT DRIVER'S LICENCE (Number and State) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

7. CURRENT MONTHLY BILLS AND EXPENSES

For each expense that everyone in your household has, please list monthly estimate of what each item costs your household.

RENT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

WATER $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ELECTRICITY $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

GAS (for home) $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HOME PHONE/CELL PHONE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CABLE/TV SERVICES $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

INTERNET $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SECURITY SYSTEM $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RENTER'S INSURANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CAR INSURANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

LIFE INSURANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HEALTH INSURANCE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CHILDCARE $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

GYM MEMBERSHIPS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DUES/SUBSCRIPTIONS $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

GROCERIES $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

HOUSEHOLD SUPPLIES (cleaning, diapers, etc.) $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CLOTHING $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

EATING OUT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PERSONAL (haircuts, nails, etc.) $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

LAUNDRY/DRY CLEANING $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

CIGARETTES $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

ENTERTAINMENT $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PET CARE (food, vet, etc.) $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

GIFTS (birthdays, holidays, etc.) $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

SCHOOL TUITION/SUPPLIES $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

VACATION/TRAVEL $ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

APPLICATION FOR HOUSING

1. APPLICATION INFORMATION

APPLICANT #1

CO-APPLICANT

OTHER HOUSEHOLD MEMBERS

2. HOUSING HISTORY

APPLICANT #1

IF YOU CURRENTLY OWN YOUR RESIDENCE

IF YOU RENT YOUR RESIDENCE

FORMER ADDRESSES FOR PAST 2 YEARS

CO-APPLICANT

IF YOU CURRENTLY OWN YOUR RESIDENCE

IF YOU RENT YOUR RESIDENCE

FORMER ADDRESSES FOR PAST 2 YEARS

CONDITION OF YOUR CURRENT LIVING PLACE

WHY DO YOU NEED A HABITAT HOME?

3. EMPLOYMENT HISTORY

APPLICANT #1

CURRENT EMPLOYER

SECONDARY EMPLOYER

PREVIOUS EMPLOYERS

PREVIOUS EMPLOYERS

CO-APPLICANT

CURRENT EMPLOYER

SECONDARY EMPLOYER

PREVIOUS EMPLOYERS

PREVIOUS EMPLOYERS

4. MONTHLY HOUSEHOLD INCOME AND RESOURCES

JOBS-BASE SALARY, EARNINGS (BEFORE TAXES AND DEDUCTIONS)

JOBS-OVERTIME, BONUSES, COMMISSIONS

UNEMPLOYMENT

PENSION

CHILD SUPPORT

ALIMONY

SOCIAL SECURITY

SSI

DISABILITY

TANF/FAMILIES FIRST/AFDC

FOOD STAMPS

REGULAR FINANCIAL SUPPORT FROM OTHERS

OTHER

5. CHECKING, SAVINGS, AND OTHER ACCOUNTS

ACCOUNT #1

ACCOUNT #2

ACCOUNT #3

ACCOUNT #4

6. OTHER ASSETS

7. CURRENT MONTHLY BILLS AND EXPENSES

8. DEBTS, LOANS, AND OTHER CREDIT ACCOUNTS

CAR LOANS

CREDIT CARDS

STUDENT LOANS

OTHER LOANS (CASH, PAYDAY, PERSONAL, TITLE, FURNITURE, RENTAL, ETC.)

OTHER LOANS (CASH, PAYDAY, PERSONAL, TITLE, FURNITURE, RENTAL, ETC.)

OTHER LOANS (CASH, PAYDAY, PERSONAL, TITLE, FURNITURE, RENTAL, ETC.)

CHILD SUPPORT (YOU PAY)

ALIMONY (YOU PAY)

GARNISHMENTS

COLLECTIONS

JUDGMENTS/LIENS

9. DOWN PAYMENT AND CLOSING COSTS

10. TAX RETURN

11. WILLINGNESS TO PARTNER

12. DECLARATIONS

13. AUTHORIZATION AND RELEASE

APPLICATION FOR HOUSING

APPLICATION FOR HOUSING

1. APPLICATION INFORMATION

APPLICANT #1

CO-APPLICANT

OTHER HOUSEHOLD MEMBERS

2. HOUSING HISTORY

APPLICANT #1

IF YOU CURRENTLY OWN YOUR RESIDENCE

IF YOU RENT YOUR RESIDENCE

FORMER ADDRESSES FOR PAST 2 YEARS

CO-APPLICANT

IF YOU CURRENTLY OWN YOUR RESIDENCE

IF YOU RENT YOUR RESIDENCE

FORMER ADDRESSES FOR PAST 2 YEARS