Homeownership Program Intake Form

Contact Info

Information for Government Monitoring Purposes

The following information is requested by the federal government for programs related to the purchase of homes, in order to monitor the organization’s compliance with equal credit opportunity and fair housing laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it or not. However, if you choose not to furnish it, under federal regulations the organization is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the information below, please check the box below.

Possible Home Locations

Please select the areas below that would be a desired location for a future Habitat home. **Available home locations are subject to change at any time. Home locations are contingent on home/property donations and the available property in our community. There is never a guarantee that a home can be built in any area.

Situation Information

Please answer the questions below to provide Habitat with information about your current housing needs, your ability to pay for a future home, credit history and your willingness to partner with our organization.