Pre-Qualification Questionnaire

Pre-Qualification Questionnaire

Please read this information carefully and print a copy and/or retain this information electronically for future reference. You are submitting a request for a pre-qualification, loan application, or referral form through Habitat for Humanity of Collier County. Habitat for Humanity of Collier County can provide you with some of the benefits of our services by conducting some of our business through the internet. This document informs you of your rights when receiving legally required disclosures, notices and information from Habitat for Humanity of Collier County. By completing and submitting your request through Habitat for Humanity of Collier County, you acknowledge receipt of this document and consent to the electronic delivery of such disclosures, notices, documents and other pertinent information. Electronic Communications Disclosures, notices and information related to this request will be provided to you electronically. However, if you wish to obtain a paper copy of any notice or disclosure, you may write to Habitat for Humanity of Collier County at 11145 Tamiami Trail E, Naples, FL 34113, with the details of your request. Paper copies will be provided to you at no charge. You may withdraw your consent at any time by contacting us at Habitat for Humanity of Collier County. Joint Accounts - If you are applying jointly with another person, either one of you may consent to receive or cancel electronic disclosures and notifications. Such consent shall apply to all owners. System Requirements - In order for you to access and retain your notifications and disclosures, your personal computer must have internet and email access. Changes to your Contact Information - You should keep us informed of any change in your electronic mailing address. Please notify us immediately of any changes to your email address or your system capabilities that enable you to receive electronic notification and disclosures.

I Agree*

First Name*

Please only use letters A-Z. No special characters

Middle Name

Please only use letters A-Z. No special characters

Last Name*

Please only use letters A-Z. No special characters

Suffix

Select

Date of Birth*

Street Address*

Unit #

City*

Select or enter value

State*

Zip Code*

E-Mail*

Phone*

Phone

What is your preferred language?*

Select or enter value

Please indicate the preferred language below:

If you chose "Other" in the previous question, please write in your preferred language.

How did you hear about this program?*

Select

Other Referral

If you chose "Other" in the previous question, how did you hear about us?

Have you applied to this program in the past?*

Please select yes if you have applied to Habitat Collier's Homebuying Program in the last 5 years.

Yes

Have you lived or worked in Collier County for the last 12 months or longer?*

Yes

Have you been unemployed or have had unverifiable income in the last 12 months or more?*

Yes

Have you ever owned a home or been on the deed for any property?*

Yes

Have you ever been convicted of a federal crime or any of the crimes listed below?*

(Sexual Misconduct, Disorderly conduct involving disturbance of neighbor; Criminal activity involving destruction of property; Two or more misdemeanor drug-related convictions related to manufacturing, delivery or sale; Any drug-related felony; Violent crimes including: murder, child abuse, sexual assault, battery, aggravated assault and assault with a deadly weapon.)

Yes

Are you able to set aside money for other costs of home ownership?*

e.g. down payment, closing costs, moving costs, new furniture, repairs, and home improvements.

Yes

I am willing to make a commitment to the Habitat program, which requires that homeowner candidates earn sweat equity hours and attend a series of homeownership classes.

I Agree*

Information For Government Monitoring Purposes

ALL applications will be considered without regard to race, color, religion, sex, or national origin. The following information is required by the Federal government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may neither discriminate on the basis of this information, nor on whether you choose to not furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. However, if you choose not to furnish ethnicity, race, or sex, under federal regulations, this Lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the above information, Lender must review the above material to assure the disclosures satisfy all requirements to which the Lender is subject under applicable law for the loan applied for. Habitat for Humanity is an equal opportunity non-profit organization dedicated to a policy of non-discrimination on any basis including race, color, age, sex, religion, handicap or national origin.

Gender*

Male

Female

I do not wish to furnish this information

Ethnicity*

Hispanic or Latino

Not Hispanic or Latino

I do not wish to furnish this information

Is there a co-applicant?*

Yes

Co-Applicant First Name*

Co-Applicant Middle Name

Co-Applicant Last Name*

Co-Applicant Suffix

Select

Co-Applicant Date of Birth*

Co-Applicant Address*

Co-Applicant Unit #

Co-Applicant City*

Co-Applicant State*

Select

Co-Applicant Zip Code*

Co-Applicant E-mail*

Co-Applicant Phone*

Phone

Co-Applicant - What is your preferred language?*

Select or enter value

Please indicate the preferred language below:

If you chose "Other" in the previous question, please write in your preferred language.

Co-Applicant - Have you applied to this program in the past?*

Please select yes if you have applied to Habitat Collier's Homebuying Program in the last 5 years.

Yes

Co-Applicant - Have you lived or worked in Collier County for the last 12 months or longer?*

Yes

Co- Applicant - Have you been unemployed or have had unverifiable income in the last 12 months or more?*

Yes

Co-Applicant - Have you ever owned a home or been on the deed for any property?*

Yes

Co-Applicant - Have you ever been convicted of a federal crime or any of the crimes listed below?*

Yes

Co-Applicant - Are you able to set aside money for other costs of home ownership?*

e.g. down payment, closing costs, moving costs, new furniture, repairs, and home improvements.

Yes

I am willing to make a commitment to the Habitat program, which requires that homeowner candidates earn sweat equity hours and attend a series of homeownership classes.

I Agree*

Information For Government Monitoring Purposes

Co-Applicant Gender*

Male

Female

I do not wish to furnish this information

Co-Applicant Ethnicity*

Hispanic or Latino

Not Hispanic or Latino

I do not wish to furnish this information

How many people (including applicant and co-applicant) would be living in the house?*

Please enter a number from the dropdown

Select

Total Household Monthly Income

List the total monthly income of all applicants. Include income from these sources: Wages (before taxes and deductions), Social Security, alimony, child support, any other regular monthly income. Please list each different type of income along with the monthly amount. There is a minimum annual income of $35,000 per year (depending on debt) required to participate in this program.

Monthly Wages*

Monthly income of all applicants. This should not include Social Security, Alimony, Child Support, or Disability payments. You will be asked for these amounts in the Additional Income section of the application.

Additional Income*

Please check all boxes that apply and provide the information for each source of income. If you have no additional income to report, please select "none."

Monthly Social Security*

Monthly Alimony*

Monthly Child Support*

Monthly Disability*

Other Monthly Income*

Total Household Monthly Expenses

List the total monthly expenses of all applicants. Include expenses from these sources: credit cards, car payments, loans such as furniture or student loans, or any other debts (do not include utilities).

Monthly Rent Payment*

Monthly Child/Spousal Support Payment*

Enter "0" if none

Total Credit Card Debt*

Enter "0" if none

Total Auto Loan Debt*

The total amount owed on all vehicle loans (not your monthly payment). Enter '0' if none

Total Student Loan Debt*

Enter '0' if none

Total Medical Debt*

Enter '0' if none

Do you have any unpaid debts that are in collections?*

Yes

By submitting this form, I/We affirm that the information on this form is true. I understand that providing false information could cause me/us to be disqualified from the Habitat program. I/We understand that a Habitat Collier Associate will contact me (via the email or phone number submitted on this form) with the results from this questionnaire and that I/We may be invited to complete a homeowner application.

I/we agree*

Habitat for Humanity of Collier County will provide to all applicants, equal opportunity to obtain housing regardless of religion, race, color, gender, physical or mental disabilities, national origin or familial status. HFHCC will not discriminate in providing opportunity for sale or financing of housing and will assist all persons who feel they have been discriminated against because of religion, race, color, gender, physical or mental disabilities, national origin, or familial status to seek equity under federal and state laws by providing information on how to file a complaint with the Florida Commission on Human Rights.

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