Habitat Peoria | Pre-Screening Application

Account Information

First Name

Last Name

address

City

state

Zip Code

Email

Phone

Spouse/Co-Application Information

First Name

Last Name

address

City

state

Zip Code

Email

Phone

Household Information

Number of adults in household

Number of children in household

Names & Ages of household members

Length of residency in the Greater Peoria Area

I am a U.S. citizen or permanent resident

Yes No

Gross monthly household income(Including wages, Social Security, Disability, Child Support, Alimony, and any other income)

Current Living Conditions (check all that apply)

Currently homeless or in temporary shelter Overcrowded living conditions Living in a home with major maintenance problems Living in an unsafe neighborhood or facing threats to personal safety Paying more than 30% of income toward rent or utilities Living in subsidized/public housing (Section 8, etc.) Other

Applicant & Co-Applicant Disclosures

Do any of these situations apply to any members in the household?

I am in debt resulting from a court decision

Yes No

I have declared bankruptcy within the past 4 years

Yes No

I have foreclosed on a property within the past 4 Years

Yes No

I am currently involved in a lawsuit

Yes No

I am paying Alimony or Child Support

Yes No

I have been required to register as a sex offender

Yes No

I have been convicted of a felony or misdemeanor within the past 10 years

Yes No

Failure to answer one or more of these questions honestly may result in disqualification from the Habitat for Humanity Greater Peoria Area program. Answering yes does not automatically disqualify you; however, if you answer yes to any of the above questions, please provide an explanation in the blank space below.

Program Requirements

I understand the following is required for my participation in the home ownership program

Ability to save $2,000 for down payment/insurance within 10 months

Yes No

Willingness to complete 250–500 hours of sweat equity (per adult over 18)

Yes No

Willingness to attend required workshops

Yes No

Willingness to partner with Habitat for Humanity to purchase a home with a no-interest mortgage

Yes No