Halifax/Northampton Habitat for Humanity

HALIFAX-NORTHAMPTON HABITAT FOR HUMANITY (rev. 10/30/2013)

1152 Highway 48 South Roanoke Rapids, NC 27870

252-537-2556 email:

APPLICATION FOR HOMEOWNERSHIP

For office use only: Date Received: ______Date of Home Visit: ______Result: ______

Applicant’s Full Name ______

Age ____ Birth Date ______U.S. citizen ______Non-U.S. citizen but permanent resident ______

yes/no yes/no

Marital Status: ______(If separated or divorced, legal documentation is required.)

Phone No. ______2nd Phone No. ______Email: ______

Current Address ______

City ______State ______Zip ______Years at this address: _____

Current Mailing Address (if different than above) ______

Previous Address ______

City ______State ______Zip ______Years at this address: _____

Co-Applicant’s Full Name ______

Age ______Birth Date ______U.S. Citizen _____ Non-U.S. Citizen but permanent resident ______

yes/no yes/no

Marital Status: ______(If separated or divorced, legal documentation is required.)

Phone No. ______2nd Phone No. ______Email: ______

Current Address ______

City______State ______Zip ______Years at this address: _____

Education Completed: Applicant ______Co-Applicant ______

H.S./College/Trade School H.S./College/Trade School

DEPENDENTS AND OTHERS LIVING IN YOUR CURRENT HOME

NameSexAgeRelationship

1. ______

2. ______

3. ______

4. ______

Page 1

DESCRIBE YOUR PRESENT HOUSING SITUATION

Number of Bedrooms ______If renting, how much rent do you pay each month? ______

To whom do you pay rent? ______

Address ______Phone No. ______

Do you own any land or property? ______If so, where? ______

Describe your current living conditions and why you need a Habitat home ______

______

If moving to a new area, are you able to commute to work? ______

Are you comfortable with new neighbors, schools, church, etc.? ______

Are you willing to have photos taken of your present living conditions? ______

INCOME AND ASSETS: What is the total income before taxes for the applicant and co-applicant? This should include wages, Social Security, AFDC, child support, food stamps, alimony, etc.

Occupant’s NameSource of Income Amt./Month Amt/Year

1.______2.______3.______4.______

Employer’s Name/Company NameCo-Applicant’s Employer & Company Name

______

Address ______Address ______

Phone No. ______Phone No. ______

How long with this employer? ______How long with this employer? ______

If less than one year, give former employment information (use back of page if needed)

______

No. of hours worked each week ______

Your Assets are: Cash ______Savings ______Car ______Other ______

$ amount $ amount make/model

Page 2

LIABILITIES / INDEBTEDNESS: To whom does your family owe money? (alimony, child support, medical bills, education loans, car payments, credit cards, utilities, etc.)

ItemTo WhomPhone Number Total Amt Owed Amt Pd/Month

______

Have you ever filed for bankruptcy? ______If yes, what year? ______

Are you currently involved in a lawsuit? ______

Do you have any judgments against you? ______

REFERENCES

List two current personal (non-relative) references, two current credit references and an additional reference such as a person from a church, a service organization, etc.

NameAddressPhone(s) How you know this person

Personal______

Personal ______

Credit ______

Other ______

ADDITIONAL DOCUMENTS REQUIRED for the Applicant and Co-Applicant

The most recent Income Tax Return
Last month’s bills
Last month’s checking account statement
Last month’s savings account statement
If separated from spouse, verification of legal separation, divorce or post-nuptial agreement
A recent free credit report. You may call 1-877-322-8228 or go to
Copy of your driver’s license
Copy of your Social Security card.

Page 3

AGREEMENTS

Halifax-Northampton Habitat for Humanity screens potential staff, board members, volunteers and applicant families against the Sexual Offender Registry. A criminal background check may also be done. By signing this application, I am agreeing to submit to such inquiries.

To receive a Habitat for Humanity home, each adult applicant must agree to complete 200 hours of sweat equity work. Each applicant’s child age 16 or older must complete 50 hours of sweat equity work. By signing the attached Sweat Equity Commitment and this application, I am agreeing to complete the required sweat equity hours on my home and elsewhere as directed per the Sweat Equity Policy.

By signing this application, I hereby give permission to the Family Selection Committee and the Halifax-Northampton Habitat for Humanity Board of Directors to obtain any information needed to verify any part of this application, including the credit check and references.

By signing this application, I agree to allow Habitat for Humanity to use my name and/or photos for the purpose of publicizing the work and goals of its organization.

By signing this application, I affirm that all of the statements that I have given in this application are truthful and are made voluntarily.

Signature of Applicant ______Date ______

Signature of Co-Applicant ______Date ______

This application MUST be completed in full. The back of this application or additional pieces of paper may be used to complete this application. This application and all of the required additional documents mustbecompleted and submitted in order for your application to be reviewed.

With sufficient postage, please mail this completed application and the requested additional documents to:

Mrs. Carlton Garner

75 Three Bridges Road

Roanoke Rapids, NC 27870

Federal law prohibits Habitat for Humanity from discriminating against any person because of race, color, religion, sex, handicap, familial status, or national origin.

Page 4

SWEAT EQUITY COMMITMENT

Sweat equity is the time and physical involvement that the Partner family, their extended family, and theirfriends devote to the construction of the future Partner’s home and/or other pre-approved H-N HFH activities.

The number of sweat equity hours required, unless adjusted by H-N HFH, are as follows:

each Partner applicant age 18 or older must work a minimum of 200 hours
each Partner applicant’s child age 16 or older who will be living in the home must work 50 hours
extended family &friends of the Partner applicant may work a total up to 50% of the required hours

 the Partner applicant’s commitment to work continues until the home is completed, even if the total

sweat equity hours have been completed.

Thank you for agreeing to assist this Partner applicant in fulfilling the required sweat equity requirements.

You do not need to possess any construction skills or experience to offer sweat equity assistance on the project.

However, if you do have a skill to offer, please list it.

Offering to make lunches for the volunteers counts 1 hour per day towards the Partner applicant’s sweat equity.

[Partner Applicant: Please attach an extra sheet of paper for additional commitment signature, hours and skills.]

200

Applicant Signature # of hours requiredConstruction Skill

______200______

Co-Applicant Signature# of hours requiredConstruction Skill

50/child

Children Age 16 or older Signatures# of hours requiredConstruction Skill

______

Extended Family or FriendName/Signature # of hours pledgedConstruction Skill

______