Which County do you currently reside in?* VictoriaJacksonLavacaDeWittGoliadCalhounBackNextHomeowner Interest Survey Applicant Name* First NameLast Name Email example@example.com Phone Number Please enter a valid phone number.Format: (000) 000-0000. How many adults are in the household* including applicant How many children are in the household Monthly wages before tax and deductions, Social Security, or Disability, benefit payments, Alimony, Child Support or any other regular income* Monthly wages before tax and deductions, Social Security, or Disability, benefit payments, Alimony, Child Support or any other regular income* Are you self-employed?* YesNo Have you owned a home or been on the deed for any property in the last 3 years?* YesNo Have you (and/or your co-applicant filled for bankruptcy in the past 7 years?)* YesNo Will the Habitat house be your primary residence?* YesNo Have you been sent to collections for outstanding debts?* YesNo If selected, will you complete the necessary partnership hours?* YesNoSingle applicant hours are 200, (co-applicants hours are 250). Have you lived in Victoria, Jackson, Lavaca, DeWitt or Goliad County for the past 12 months?* YesNo Do you have 24 consecutive months of work history?* YesNo Have you been at your current job for at least 12 months?* YesNoPLEASE BE ADVISED THIS IS NOT A MORTGAGE LOAN APPLICATION household tot calc AMI Boolean (T ^ T) SubmitShould be Empty:
