mutual self-help homeownership program Pre-Qualification Form Pre-Qualification Form for Homeownership Please enable JavaScript in your browser to complete this form.Applicant Name *FirstLastCo-Applicant NameFirstLastPhysical Address: *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing Adddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail Address *Phone Number *Are you a veteran? YesNoDo you have any elderly (62+) or disabled HOUSEHOLD members? *YesNoHave you lived or worked in Lewis and Clark county for 1 year or more?YesNoHow long have you lived or worked in Lewis and Clark county?Are ALL ADULT HOUSEHOLD MEMBERS U.S citizens or permanent residents? *YesNoIncluding applicant(s), how many people currently live in your household? *Please list all household members: Name, Relationship, Age *List ALL sources of monthly household income, including the income from all household members, regardless of age. Sources include, Employment, SSI, SSDI/Disability, Child Support, Kinship Care, Retirement, Workers Compensation, Unemployment, Etc. 1. Household Member Name: *FirstLastName of Income Source:Hours worked per week:Pay per hour:Monthly GROSS Income:2. Household Member Name:FirstLastName of Income Source:Hours worked per week:Pay per hour:Monthly GROSS Income:3. Household Member Name: FirstLastName of Income Source:Hours worked per week: Pay per hour: Monthly GROSS Income: 4. Household Member Name:FirstLastName of Income Source:Hours worked per week:Pay per hour:Monthly GROSS Income:5. Household Member Name: FirstLastName of Income Source:Hours worked per week:Pay per hour:Monthly GROSS Income: Please Upload Income Documentation (pay stubs, tax statements, child support, benefit statements, etc.) * Click or drag files to this area to upload. You can upload up to 10 files. List ALL monthly debt payments, including but not limited to auto loans, personal loans, credit card bills, student loans, childcare, etc. Household Member Name: *FirstLastType of Debt: *Monthly Payment Amount: *Household Member Name:FirstLastType of Debt: Monthly Payment Amount:Household Member Name:FirstLastType of Debt: Monthly Payment Amount:Household Member Name:FirstLastType of Debt: Monthly Payment Amount:Household Member Name:FirstLastType of Debt: Monthly Payment Amount:Information about your home:How much are you currently paying each month for housing? *Do you recieve any rent subsidy? (section 8, helena housing, public housing) *YesNoList ALL adult household members:Household Member Name: *FirstLastDo you know your credit score? *YesNoWhat is your credit score? How do you track your credit score? (Mint.com, Credit Karma, Experian, Equifax, TransUnion, FICO, etc.) To your knowledge, do you have any major credit delinquencies (past due payments or bills in collections)? *YesNoIf yes, please explain:Have you ever filed for bankruptcy? *YesNoIf yes, date of discharge:Household Member Name: FirstLastDo you know your credit score?YesNoWhat is your credit score? How do you track your credit score? (Mint.com, Credit Karma, Experian, Equifax, TransUnion, FICO, etc.) To your knowledge, do you have any major credit delinquencies (past due payments or bills in collections)? YesNoIf yes, please explain:Have you ever filed for bankruptcy?YesNoIf yes, date of discharge:Household Member Name: FirstLastDo you know your credit score?YesNoWhat is your credit score? How do you track your credit score? (Mint.com, Credit Karma, Experian, Equifax, TransUnion, FICO, etc.) To your knowledge, do you have any major credit delinquencies (past due payments or bills in collections)?YesNoIf yes, please explain:Have you ever filed for bankruptcy?YesNoIf yes, date of discharge:Applicant Signature: *Clear SignatureBy my signature, I affirm that the information on this form is true and correct. I understand that providing false information could cause me to be disqualified from Helena habitat’s program. I also understand that I will receive a response to this questionnaire, and that it may take up to 2 weeks for my pre-qualification form to be reviewed and processed. I acknowledge that my receipt of a response to this form does not constitute additional services from Helena Area Habitat for Humanity. I understand that in no way am I being offered counseling services by submitting this form. IF YOU DO NOT SIGN THIS FORM, IT WILL RESULT IN IMMEDIATE DENIAL AS THE DOCUMENT WILL BE INVALID.Date / Time *DateTimeCo Applicant Signature:Clear SignatureDate / TimeDateTimeSubmit Program Information Home Repairs Program
