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

* Do you own a home?:
* Do you (the applicant) live or work in Washtenaw County?
* Are you (the applicant) a U.S. Citizen?
* If not, do you (the applicant) have a green card?
* Are you employed? (If yes, please list employment information below)
** List Amount of Assistance Recieved Each Month (if applicable) 
** You will be required to provide documentation of this income.

CO-APPLICANT

Do you own a home?:
Do you (the co-applicant) live or work in Washtenaw County?
Are you (the co-applicant) a U.S. Citizen?
If not, do you (the co-applicant) have a green card?
Are you employed? (If yes, please list employment information below)
** List Amount of Assistance Recieved Each Month(if applicable)
** You will be required to provide documentation of this income.

CONTACT INFORMATION

CREDIT INFORMATION

* Does the applicant or co-applicant have any judgments, collections or bankruptcies in their credit histories?
* Have either the applicant or co-applicant ever had a foreclosure?

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.
Are you a student?
Is this household member employed? (If yes, please be sure to include their employment information below)
Are you a student?
Is this household member employed? (If yes, please be sure to include their employment information below)
Enter information for all household members under the age of 18.
* How did you hear about us?
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.
* Do you certify and declare to the best of your knowledge and belief that the information you have provided is true, accurate, and complete?
* Indicates Response Required