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START
AGAIN HABITATS • PO Box 121397 • Ft. Worth, Texas 76121
APPLICATION
FOR HOUSING Dear
Applicant: We need
you to complete this application to
determine if you qualify for a Start Again Habitats
home. Please fill out the application
as completely and accurately as possible. All information you
include on this application will be kept
confidential. APPLICANT
INFORMATION APPLICANT________________________________________________ CO-APPLICANT_____________________________________________ Applicant’s
Name________________________________________ Co-applicant’s
Name______________________________________ Social
Security Number Social Security Number_______________________ Birthdate____________________
Birthdate____________________
Married
____ Separated ____ Unmarried ____ Married ____ Separated ____ Unmarried ____ Current
Residence Address__________________________________________________ (street,
city, state, zip code)______________________________________________________________________________ Current
Residence Address_________________________________________________ (street,
city, state, zip code)_____________________________________________________________________________ Phone
Numbers Phone Numbers Home__________________________
Work__________________________
Cell___________________________
Friend you
are staying with________________________ If above
address is less than 2 years, what was If above address is less than 2 years,
what was your
previous residence address?
______________________________________________________ your
previous residence address?
______________________________________________________ Are you a
US Citizen or permanent resident? Y/N Are you a US Citizen or permanent
resident? Y/N______ Are you a
resident of Harris County?________ Are you a resident Montgomery County?____________
How Long?
________________________________________ FOR OFFICE
USE ONLY Date
Received: _____________________________ Date
_____________________________________ Letter
____________________________________ Sent:
_____________________________________ More
Information Requested? Yes ____ No _____ Date(s) of
Home Visit(s) ______________________ Date Application
Completed: __________________ Date of
Board Approval/Denial _________________ Accepted
_______________ Denied ____________ Date
Letter Sent: ____________________________
APPLICANT/CO-APPLICANT
INFORMATION LIST
ALL PEOPLE WHO WILL LIVE IN YOUR HOME (INCLUDE APPLICANT & CO-APPLICANT)
NAME AGE
MALE/FEMALE RELATIONSHIP
TO YOU ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ ________________________________
_____ _____________ _____________________ (If you
are raising children other than your own (such as grandchildren, nieces, or
nephews) please indicate whether you are the child’s legal guardian.)
_________________________________________________________
WILLINGNESS
TO PARTNER To be
considered for a Start Again
home, you and your family must be willing to complete a certain number of “sweat
equity” hours. Your help in improving your home and/or the homes of
others is called “sweat-equity,”
and may include clearing the lot of debres, planting shrubs, helping with
painting, working on the roof, or other activities needed to improve a home. I AM
WILLING TO COMPLETE THE REQUIRED SWEAT EQUITY HOURS APPLICANT
_____________________________ CO-APPLICANT ____________________________ PRESENT
HOUSING SITUATION OWN
_________ RENT
________ OTHER
(Please describe) ___________________________ NUMBER OF
BEDROOMS: (Please circle) 1 2 3 4 5 OTHER
ROOMS IN THE HOUSE: (Please circle) Kitchen Bathroom(s) Living Room Dining
Room Other (Please describe) ________ IF YOU
RENT, WHAT IS YOUR MONTHLY RENT? ________________________ (Please
supply a copy of your lease or a copy of a money order receipt or cancelled
check.) Name,
address and phone number of landlord or property manager:
_________________________________ Describe the condition of the house or apartment where you live. Why do you need a Habitat home? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
EMPLOYMENT/FINANCIAL
INFORMATION APPLICANT Name and address of CURRENT employer __________________________________________________ Employer’s Business Phone______________________________ Date started/Years on the job Date started/Years on the job_____________________________________ Monthly (Gross-before tax) Wages______________________________________ CO-APPLICANT Name and address of CURRENT employer__________________________________________________ Employer’s
Business Phone______________________________ Date
started/Years on the job Date started/Years on the job_____________________________________ Monthly
(Gross-before tax) Wages______________________________________ OTHER
INCOME APPLICANT
AND OTHERS IN HOUSEHOLD FOOD
STAMPS ____________ SOCIAL
SECURITY _________ DISABILITY
______________ CHILD
SUPPORT___________ OTHER
(Specify)
MONTHLY
BILLS APPLICANT
AND CO-APPLICANT/OTHERS IN HOUSEHOLD CAR
PAYMENTS__________________________ HEALTH
INSURANCE______________________ CREDIT
CARD____________________________ CREDIT
CARD____________________________ CREDIT
CARD____________________________ CHILD
SUPPORT__________________________ LOAN___________________________________
OTHER(S)
(Specify)_______________________________________________ REFERENCES
Applicant
and Co-Applicant must provide the following references: 1.
Landlord or property manager of rental unit you live in. Name Address and Phone
Number. 2.
Employer for current primary employment. 3. One
friend, neighbor, church pastor or other person that can tell about your
character (not family). I
understand that by filing this application,
I am authorizing Start Again Habitats to
evaluate my actual need for a SAH
home, my ability to take care of the home and my willingness to help with SAH.
I understand that the evaluation will include personal visits, employment
verification, and contact of references. I understand that I have answered all
questions on this application
truthfully and to the best of my ability. I understand that if I have not
answered the questions truthfully, my application
may be denied, and that even if already
selected to receive a Habitat home, I may be
disqualified from the program. APPLlCANT’S
SIGNATURE AND DATE: _____________________________________
______________ CO-APPLICANT’S SIGNATURE AND DATE: __________________________________ ______________ Mail to: START AGAIN HABITATS. PO Box 121397, Ft. Worth, Texas 76121
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