Single Applicant or Co-Applicants?(Required)ApplicantCo-ApplicantsApplicantName(Required) First Middle Last Social Security Number(Required)This field is hidden when viewing the formMonthly Income, if applicableDate of Birth(Required) MM slash DD slash YYYY This field is hidden when viewing the formAgeThis field is hidden when viewing the formToday's Date MM slash DD slash YYYY This field is hidden when viewing the formAge (calculated)Where would you like your house?(Required)San AntonioSeguinNew BraunfelsCounty(Required)Which county do you work or live in?BexarAtascosaBanderaComalGuadalupeKendallMedinaWilsonOtherCounty (other)(Required) Physical Address - NO PO Box address - Include APT # if applicable(Required) Street Address City ZIP Code Use Physical Address for Mailing? Use physical address Mailing Address(Required) Street Address City ZIP Code Email(Required) Phone(Required)Alternate PhoneThis field is hidden when viewing the formWork PhoneMarital Status(Required) Married Divorced Separated Single Widow Gender(Required) Male Female Veteran?(Required)YesNoApplicant Income InformationEmployment Type(Required)HourlySalaryNot ApplicablePer Hour ($)(Required)Hours Per Week(Required)Per Month ($)(Required)This field is hidden when viewing the formPer Hour ($)Applicant additional income sourcesIf you receive SSI, social security and/or child support, how much per month?SSI income amountChild support income amountSocial security income amountAdditional income sourcePensionSecond JobVA BenefitsOtherAdditional income amountCo-ApplicantCo-Applicant Name(Required) First Middle Last Co-Applicant Social Security NumberThis field is hidden when viewing the formMonthly Income, if applicableCo-Applicant Date of Birth MM slash DD slash YYYY This field is hidden when viewing the formAgeCo-Applicant Physical Address - NO PO Box address - Include APT # if applicable(Required) Street Address City ZIP Code Co-Applicant Use Physical Address for Mailing? Use physical address Co-Applicant Mailing Address(Required) Street Address City ZIP Code Co-Applicant Email Co-Applicant PhoneCo-Applicant Alternate PhoneThis field is hidden when viewing the formCo-Applicant Home PhoneRelationship to ApplicantSpouseChildParentSiblingOtherCo-Applicant Marital Status Married Divorced Separated Single Widow Gender Male Female Veteran?YesNoRelationship to Applicant (other)(Required)Co-Applicant Income InformationEmployment TypeHourlySalaryNot ApplicablePer Hour ($)(Required)Hours Per Week(Required)Per Month ($)(Required)Co-Applicant additional income sourcesIf you receive SSI, social security and/or child support, how much per month?SSI income amountChild support income amountSocial security income amountAdditional income sourceChild SupportPensionSecond JobSocial SecuritySSIVA BenefitsOtherAdditional income amountOtherDoes the applicant or co-applicant currently own a house or has either person owned a house within the past three years(Required) Yes No Are you interested in an existing Habitat home?(Required) No Yes Existing property's addressHow did you hear about Habitat for Humanity(Required) Billboard Case Worker Community Event Employer Facebook Family/Friend Flyer Google Habitat Homeowner School TV Radio Other How did you hear (other)Other Household MembersList all the names of the persons that will be living in the home (excluding the Applicant or Co-Applicant)Do Not Include: Applicant/Co-Applicant This field is hidden when viewing the formApplicant name(Required) First Last This field is hidden when viewing the formRelationship(Required)SelfThis field is hidden when viewing the formCo-applicant name First Last First household memberName First Last Relationship(Required)Aunt/UncleChildCousinGrandchildGrandparentNiece/NephewOtherParentGender(Required) Male Female DOB(Required)Veteran?(Required)YesNoRelationship to Applicant (other)(Required)Monthly Income(Required) Second household memberName First Last Relationship(Required)Aunt/UncleChildCousinGrandchildGrandparentNiece/NephewOtherParentGender(Required) Male Female DOB(Required)Veteran?(Required)YesNoRelationship to Applicant (other)(Required)Monthly Income(Required) Third household memberName First Last Relationship(Required)Aunt/UncleChildCousinGrandchildGrandparentNiece/NephewOtherParentGender(Required) Male Female DOB(Required)Veteran?(Required)YesNoRelationship to Applicant (other)(Required)Monthly Income(Required) Fourth household memberName First Last Relationship(Required)Aunt/UncleChildCousinGrandchildGrandparentNiece/NephewOtherParentGender(Required) Male Female DOB(Required)Veteran?(Required)YesNoThis field is hidden when viewing the formRelationship(Required)Aunt/UncleChildCousinGrandchildGrandparentNiece/NephewOtherParentRelationship to Applicant (other)(Required)Monthly Income(Required) Fifth household memberName First Last Relationship(Required)Aunt/UncleChildCousinGrandchildGrandparentNiece/NephewOtherParentGender(Required) Male Female DOB(Required)Veteran?(Required)YesNoRelationship to Applicant (other)(Required)Monthly Income(Required) Sixth household memberName First Last Relationship(Required)Aunt/UncleChildCousinGrandchildGrandparentNiece/NephewOtherParentGender(Required) Male Female DOB(Required)Veteran?(Required)YesNoRelationship to Applicant (other)(Required)Monthly Income(Required) DEBTS (both applicant and co-applicant)What are your current monthly payments? Ex. car payments, credit card,personal and/or student loans,child support. List all debts you are responsible for paying.PersonApplicantCo-ApplicantOccupantType of AccountAuto LoanEducationChild Support PaymentCredit CardDepartment StorePersonal LoanOtherMonthly PaymentBalancePersonApplicantCo-ApplicantOccupantType of AccountAuto LoanEducationChild Support PaymentCredit CardDepartment StorePersonal LoanOtherMonthly PaymentBalancePersonApplicantCo-ApplicantOccupantType of AccountAuto LoanEducationChild Support PaymentCredit CardDepartment StorePersonal LoanOtherMonthly PaymentBalancePersonApplicantCo-ApplicantOccupantType of AccountAuto LoanEducationChild Support PaymentCredit CardDepartment StorePersonal LoanOtherMonthly PaymentBalancePersonApplicantCo-ApplicantOccupantType of AccountAuto LoanEducationChild Support PaymentCredit CardDepartment StorePersonal LoanOtherMonthly PaymentBalancePersonApplicantCo-ApplicantOccupantType of AccountAuto LoanEducationChild Support PaymentCredit CardDepartment StorePersonal LoanOtherMonthly PaymentBalanceCredit Authorization (please read and sign)Credit Authorization (please read and sign) I/We hereby give Habitat For Humanity of San Antonio, Inc. authorization to obtain information on my/our credit. Verification of such information may be made at anytime by the lender, its agents, successors or assigns either directly through a credit reporting agency. Credit Authorization Consent(Required) Yes, I agree Co-Applicant Credit Authorization Consent(Required) Yes, I agree Applicant Signature(Required)Co-Applicant Signature(Required)This field is hidden when viewing the formDate Signed MM slash DD slash YYYY
