Pre-Qualification Questionnaire

Open enrollment is officially here!

Apply anytime from today until April 24.

"*" indicates required fields

Step 1 of 5

20%

CONSENT TO RECEIVE ELECTRONIC DISCLOSURES UNDER THE ELECTRONIC SIGNATURES IN GLOBAL AND NATIONAL COMMERCE ACT (E-SIGN Act)

Please read this information carefully and print a copy and/or retain this information electronically for future reference. You are submitting a request for a pre-qualification, loan application, or referral form through Habitat for Humanity of Broward. Habitat for Humanity of Broward can provide you with some of the benefits of our services by conducting some of our business through the internet. This document informs you of your rights when receiving legally required disclosures, notices and information from Habitat for Humanity of Broward.

By completing and submitting your request through Habitat for Humanity of Broward, you acknowledge receipt of this document and consent to the electronic delivery of such disclosures, notices, documents and other pertinent information.

Electronic Communications Disclosures, notices and information related to this request will be provided to you electronically. However, if you wish to obtain a paper copy of any notice or disclosure, you may write to Habitat for Humanity of Broward at 888 NW 62nd St, Ft. Lauderdale 33309 with the details of your request. Paper copies will be provided to you at no charge. You may withdraw your consent at any time by contacting us at Habitat for Humanity of Broward.

Joint Accounts If you are applying jointly with another person, either one of you may consent to receive or cancel electronic disclosures and notifications. Such consent shall apply to all owners.

System Requirements In order for you to access and retain your notifications and disclosures, your personal computer must have internet and email access.

Changes to your Contact Information You should keep us informed of any change in your electronic mailing address. Please notify us immediately of any changes to your email address or your system capabilities that enable you to receive electronic notification and disclosures.

Required*

I Agree

Have you (and co-applicant) lived or worked in Broward County for the last 12 months?*

YES

Have you (and/or co-applicant) ever owned a home or been on the deed for any property?*

YES

Have you (and/or co-applicant) filed for bankruptcy in the last 3 years?*

YES

Have you (and/or co-applicant) been out of work in the last year?*

YES

Have you (and/or co-applicant) ever been convicted of a federal crime or any of the crimes listed below?*

(Sexual Misconduct, Disorderly conduct involving disturbance of neighbor; Criminal activity involving destruction of property; Two or more misdemeanor drug-related convictions related to manufacturing, delivery or sale; Any drug-related felony; Violent crimes including: murder, child abuse, sexual assault, battery, aggravated assault and assault with a deadly weapon.)

YES

Thank you for your interest in becoming a Habitat Homeowner. At this time, we regret that you are not eligible for this program.

Applicant Information

First Name*

Last Name*

Address*

Street Address City ZIP Code

Email*

Enter Email Confirm Email

Phone*

Occupation*

Employer/Company Name*

Is there a co-applicant?*

YES

Co-applicant Information

First Name*

Last Name*

Address*

Street Address City ZIP Code

Email*

Enter Email Confirm Email

Phone*

Occupation*

Employer/Company Name*

I/we are willing to make a commitment to the Habitat program, which requires that homeowner candidates earn sweat equity hours and attend a series of homeownership classes.*

I Agree

Household Residents

Applicant Name:

Applicant First Name*

Applicant Last Name*

Co-Applicant Name:

Co-Applicant First Name*

Co-Applicant Last Name*

NOT including the above-mentioned applicant(s), how many people would be living in the house?*

Please enter a number from 0 to 9.

Name #1*

Date of Birth #1*

MM slash DD slash YYYY

Gender #1*

Name #2*

Date of Birth #2*

MM slash DD slash YYYY

Gender #2*

Name #3*

Date of Birth #3*

MM slash DD slash YYYY

Gender #3*

Name #4*

Date of Birth #4*

MM slash DD slash YYYY

Gender #4*

Name #5*

Date of Birth #5*

MM slash DD slash YYYY

Gender #5*

Name #6*

Date of Birth #6*

MM slash DD slash YYYY

Gender #6*

Name #7*

Date of Birth #7*

MM slash DD slash YYYY

Gender #7*

Name #8*

Date of Birth #8*

MM slash DD slash YYYY

Gender #8*

Name #9*

Date of Birth #9*

MM slash DD slash YYYY

Gender #9*

Total Household Monthly Income
List the combined total of verifiable, monthly income of both applicant & co-applicant. Include income from these sources: Wages (before taxes and deductions), Social Security, alimony, child support, any other regular monthly income. Please list each different type of income along with the monthly amount. Enter “0” if no income.

Monthly Wages*

Please enter a number from 0 to 9999.

Calculated Annual Wages

Monthly Social Security*

Please enter a number from 0 to 9999.

Calculated Annual Social Security

Monthly Alimony*

Please enter a number from 0 to 9999.

Calculated Annual Alimony

Monthly Child Support*

Please enter a number from 0 to 9999.

Calculated Annual Child Support

Monthly Disability*

Please enter a number from 0 to 9999.

Calculated Annual Disability

Other Taxable Monthly Income*

Please enter a number from 0 to 9999.

Calculated Annual Other Income

Please Describe Other Taxable Income*

TOTAL MONTHLY INCOME

Total Household Monthly Expenses
List the total monthly expense of all applicants. Include expenses from these sources: credit cards, car payments, loans such as furniture or student loans, or any other debts (do not include utilities). incom

Monthly Rent Payment*

Please enter a number from 0 to 9999.

Calculated Annual Rent Payment

Total Credit Card Debt*

Please enter a number from 0 to 99999.

Monthly Credit Card Payment*

Please enter a number from 0 to 9999.

Total Car Debt*

Please enter a number from 0 to 99999.

Monthly Car Payment*

Please enter a number from 0 to 9999.

Total Student Loan Debt*

Please enter a number from 0 to 99999.

Monthly Student Loan Payment*

Please enter a number from 0 to 99999.

Other Monthly Loan Payments*

Please enter a number from 0 to 99999.

Please Specify Other Loans*

Monthly Alimony/Child Support Payment*

Please enter a number from 0 to 9999.

Calculated Annual Payments

TOTAL MONTHLY EXPENSES

Do you have any unpaid debts that are in Collections?*

YES

Medical Collection Amount*

Please enter a number from 0 to 99999.

Non-Medical Collection Amount*

Please enter a number from 0 to 99999.

How did you hear about us?*

Other*

By submitting this form, I/we affirm that the information on this form is true. I/We understand that providing false information could cause me/us to be disqualified from the Habitat program. I/We understand that a Habitat Associate will contact me/us (via the email submitted on this form) with the results from this questionnaire and that I/we may be invited to complete a homeownership program application.

I/We authorize Habitat for Humanity of Broward to release my/our contact information and/or applicable pre-qualification information to other organizations that may be able to help me/us with housing and/or financial counseling.

Agree to Share*

I/We authorize information to be released

I/We do NOT authorize information to be released

Applicant Full Name*

Applicant Signature*

Co-Applicant Full Name*

Co-Applicant Signature*

CAPTCHA

This field is for validation purposes and should be left unchanged.

Due to the rigorous evaluation process, you may not receive an update of your status for up to 30 days. The Homeowner Selection Committee will notify each applicant of the outcome of this process within the 30-day time period. Please submit all questions via email to homeownership@habitatbroward.org

Habitat for Humanity is an equal opportunity program. We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status, national origin or any protected status. Individuals from all races, sexes, and creeds are encouraged to apply.

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Pre-Qualification Questionnaire

Open enrollment is officially here!

Apply anytime from today until April 24.

Applicant Information

Co-applicant Information

Main

Homeowner

Giving

Volunteer

Habitat Broward Admin Offices

Address

Hours

Habitat Broward ReStore

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Hours