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Habitat for Humanity
of Huron Valley

Intake Information Form
 
Please Note: It is important to make sure that all applicable information is complete before you submit this intake form.  An incomplete intake form will not be processed.
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APPLICANT

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

CO-APPLICANT

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

CONTACT INFORMATION

CREDIT INFORMATION

OTHER HOUSEHOLD MEMBERS

Please list all family members age 18 and older (excluding the Applicant and Co-applicant) who will be living in the home.  Please list emplyoment information, if applicable.
Enter information for all household members under the age of 18.
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 understand the need to share necessary personal information with Habitat 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 to purchase 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 Habitat for Humanity at 734-677-1558 and speaking with the Family Services Director.
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* Indicates Response Required