image
 
Habitat for Humanity
of Huron Valley

Intake Information Form
calendar

CONTACT INFORMATION

APPLICANT

** List Amount of Assistance Recieved Each Month
** You will be required to provide documentation of this income.

CO-APPLICANT

** List Amount of Assistance Recieved Each Month
** You will be required to provide documentation of this income.

APPLICANT (continued)

calendar
Please list all jobs currently held by family members age 18 and older (excluding those listed above) who will be living in the home:

HOUSEHOLD

Enter information for all individuals (other than applicant and co-applicant) that will be living in the Habitat home.


Marital status only required for applicant/co-applicant.
Being interested in applying for housing through Habitat for Humanity of Huron Valley, I/We give permission for the staff of Habitat for Humanity of Huron Valley to request a copy of my/our credit report as part of the application process. I/We understand that my/our credit report will only be requested by Habitat staff after having completed a pre-screening interview over the phone or in person. I/We also understand that I/We will be notified when my/our credit report has been received.
I understand the need to share necessary personal information with the office staff in order to determine my eligibility for a Habitat for Humanity home. I understand and acknowledge that completing an intake form and initial assessment does not guarantee that I will be selected for a Habitat for Humanity home. Final selection of eligible applicants is the sole responsibility of the Habitat for Humanity of Huron Valley Board of Directors.
I understand that my personal information will be kept confidential and will only be shared between Habitat for Humanity office staff and designated volunteers. I understand that I may terminate my participation in this program at any time by contacting the Habitat for Humanity office at 734-677-1558 and speaking with our Family Services Director.
image
* Indicates Response Required


Powered by FormSite.com