Housing Partnership Program Intake Form

Albany Area Habitat for Humanity

Housing Counseling Intake Form
Have you viewed the Housing Partnership Video and/or attended a Housing Information Session within the last six months? *

Yes No
Please note: While it is not a requirement to attend and/or view the Housing Information Session, it is strongly recommended. Participating in these opportunities will help you understand our program requirements, as well as, if home ownership is right for you and your family at this time.

To attend the next available information session, please click here.

To view the information session webiner, please click here.
Date *

- Month - Day Year
Date
Name *

First Name Last Name
Email
example@example.com

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Date of Birth *

- Month - Day Year
Date
Immigration Status *
Family/Household Size (e.g. 1,3, etc) *
How many dependents?
Are there non-dependents who will be living or are living in your home? *

Yes No
If yes, please provide the relationship (e.g. brother, mother, care provider) *
Annual Gross Household Income (before taxes) *
Monthly Gross Household Income (before taxes) *
Are you currently in Chapter 13 Bankruptcy? *

Yes No
When will it be paid out? *

- Month - Day Year
Date
If yes, when did it begin? *

- Month - Day Year
Date
What is the payment? *
Have you had a Chapter 7 bankruptcy? *

Yes No
When Discharged? *

- Month - Day Year
Date
Do you have a co-applicant? *

Yes No
Co-Applicant Information
Name *

First Name Last Name
Is your address the same as the Applicant? *

Yes No

Is your phone number the same as the Applicant? *

Yes No
Phone Number *

- Area Code Phone Number
Email *
example@example.com
Date of Birth *

- Month - Day Year
Date
Immigrant Status *
Monthly Gross Income (before taxes) *
Are you currently in Chapter 13 Bankruptcy? *

Yes No
If yes, when did it begin? *

- Month - Day Year
Date
When will it be paid out? *

- Month - Day Year
Date
What is the payment? *
Have you had a Chapter 7 bankruptcy? *

Yes No
When Discharged? *

- Month - Day Year
Date
Please Describe your current housing situation (e.g. rent, own, inadequate heating, mold, etc) *
As the APPLICANT: To be considered for a Habitat home, you and your family must be willing to complete 500 hours of Sweat Equity. These hours may include the construction of your own home, participating in homeowner education classes, etc. If you are unable to do physical labor, we will accommodate you. Are you willing to complete the required sweat equity hours? *

Yes No
AS THE CO-APPLICANT: To be considered for a Habitat home, you and your family must be willing to complete 500 hours of Sweat Equity. These hours may include the construction of your own home, participating in homeowner education classes, etc. If you are unable to do physical labor, we will accommodate you. Are you willing to complete the required sweat equity hours? *

Yes No
AS THE APPLICANT: You will be required to save $1,000 towards the closing costs of your home. If selected, you will need to save $50-$100 in order to receive this goal within 9 months. Savings progress will affect home placement and time spent in the Habitat Program. *

Yes No
AS THE CO-APPLICANT: You will be required to save $1,000 towards the closing costs of your home. If selected, you will need to save $50-$100 in order to receive this goal within 9 months. Savings progress will affect home placement and time spent in the Habitat Program. *

Yes No
By clicking on the box below, you acknowledge that you have read and understand Albany Area Habitat for Humanity's Privacy Statement and Notice. *
Yes, I have read and understand AAHFH's privacy statement and notice *

Agree
Applicant Signature (use your mouse or touch pad to sign) *

Clear
Co-Applicant Signature (use your mouse or touch pad to sign) *

Clear
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Albany Area Habitat for Humanity

Co-Applicant Information