...::: Habitat for Humanity of Forsyth County, Application Form :::...

Applicant Name

Date of Birth

Co-Applicant
Name

Date of Birth

Address

City

State

Zip Code

Home Phone

Work Phone

Co-Applicant
Work Phone

OTHERS TO LIVE IN HOME

Name

Date of Birth

Relationship

Sex

Please provide information for additional people
in the space below:

PRESENT HOUSING

Apartment
House
Mobile Home

No. of Bedrooms

Payment per Month

Owned
Rented
Buying

EMPLOYMENT

Applicant's Employer

Position

Applicant's Employment Date

Hourly Rate

Hours Worked Per Week

Co-Applicant's Employer

Position

Co-Applicant's Employment Date

Hourly Rate

Hours Worked per Week

If the applicant, co-applicant or anyone else in the household does additional work, please list employer, position, employment date, total monthly pay before taxes and after taxes on a seperate sheet.

OTHER SOURCES OF INCOME

Source 1

Amount Received Monthly

Is this regular?

Source 2

Amount Received Monthly

Is this regular?

Is there anything else you would like us to know about your family, finances, housing situation, etc.? If so, describ on a seperate shet of paper.

I Agree I Disagree

I understand that Habitat for Humanity of Forsyth County reserves the right to reject any applicant for intentionally providing false or misleading information.