Applicant Intake Form

How many years have you owned your home?*

In what year was your home built?

If you don't know this information, please type N/A.

Current on payments*

Yes

No

Is your house in Foreclosure or in danger of becoming so?*

Yes

No

Not sure

Current on Insurance*

Yes

No

Current on Taxes*

Yes

No

Do you plan on selling your home?*

If you plan to sell your home in the next 5 years, please let us know when.

2 years or sooner

3 years

5 years

No plans before 5 years

Are there any current citations from the buiding department requiring repairs be made to your home?*

This would come from a code enforcement official from the City or the County

Yes

No

What are the violations?*

If you don't know the violations, please indicate so.

Primary Phone*

Phone

Primary Phone Type*

Cell

Home

Work

Secondary Phone

Phone

Secondary Phone Type

Cell

Home

Work

Email*

Property Address*

City*

State*

Zip*

What County do you live in?*

Will

Grundy

Kankakee

Confirm that this your principal place of residence (Do you live here most of the time?) by checking the box*

What is the primary language spoken in the household?*

English

Spanish

Polish

Other

What other languages are spoken in the home?

Will you require a translator?*

Please feel free to request a translator if you don't speak fluent english.

Yes

No

What is your date of birth?*

What is your Social Security Number?*

What is your Credit Score?

Household Demographic Information

PLEASE READ THE FOLLOWING BEFORE FILLING OUT ANY FURTHER INFORMATION ON THIS APPLICATION!

Will County Habitat for Humanity is an equal housing lender and only collects demographic information on the clients we serve in order to better understand the needs of our community and to ensure that we are serving all people, regardless of marital status, household composition, employment status, race, ethnicity, gender, sexual identity, or age. This information helps us to tailor our programs and services to better meet the needs of our clients and to measure our effectiveness in serving the community.

We want to assure our clients that we are inclusive and strive to serve all people equally. We do not discriminate based on any personal characteristics, and we welcome everyone to our organization. We believe that diversity and inclusion are essential values for our organization and our community.

The demographic information we collect is kept confidential and is only used in the aggregate to analyze trends and measure the effectiveness of our programs. We do not share any individual-level information with third parties without the consent of the individual. We take our responsibility to protect the privacy and confidentiality of our clients' information very seriously.

We appreciate your cooperation in providing this information and want to assure you that it will be used only for the purposes described above. Thank you for your trust and for helping us to better serve our community.

Primary Applicant

Gender Identity:

Are you a veteran of the Military or disabled? (select all that apply):

Veteran

Disabled

Spouse of a deceased Veteran

Please describe your disablity:

Sexual Identity/Sexual orientation:

Co-Owner/household-member Information

Who owns or will own the property?*

Me and others

Just me

Others own this home, not me.

2nd Co-Owner Name:*

2nd Co-Owner Date of Birth:*

Gender Identity:

Are they a veteran of the Military or disabled? (select all that apply):

Veteran

Disabled

Spouse of a deceased Veteran

Please describe their disability:

Sexual Identity/Sexual orientation:

2nd Co-Owner Cell Phone #*

Phone

2nd Co-Owner Email Address:*

2nd Co-Owner Social Security #*

Is there a 3rd additional person on the Mortgage?*

Yes

No

3rd Co-Owner Name:*

3rd Co-Owner Date of Birth:*

Gender Identity:

Are they a veteran of the Military or disabled? (select all that apply):

Veteran

Disabled

Spouse of a deceased Veteran

Please describe their disability:

Sexual Identity/Sexual orientation:

3rd Co-Owner Phone #*

Phone

3rd Co-Owner Email Address:*

3rd Co-Owner Social Security #*

Aside from people on the mortgage, how many additional people are living in the house?*

What is the name of the 1st additional person that will be living in the home?*

What is their Date of Birth?*

Gender identity:

Are they a veteran of the Military or disabled? (select all that apply):

Veteran

Disabled

Spouse of a deceased Veteran

Please describe their disability:

Sexual Identity/Sexual orientation:

Does this person provide household income?*

Yes

No

How much is this person's total income annually?*

Please include all sources of income such as Social Security, Supplemental Income, etc.

What is the name of the 2nd additional person that will be living in the home?*

What is their Date of Birth?*

Please ask them to provide their racial and ethnic identity by choosing one of the following options (select all that apply):*

Gender identity:

Are they a veteran of the Military or disabled? (select all that apply):

Veteran

Disabled

Spouse of a deceased Veteran

Please describe their disability:

Sexual Identity/Sexual orientation:

Does this person provide household income?*

Yes

No

How much is this person's total income annually?*

Please include all sources of income such as Social Security, Supplemental Income, etc.

What is the name of the 3rd additional person living in the home?*

What is their Date of Birth?*

Please ask them to provide their racial and ethnic identity by choosing one of the following options (select all that apply):*

Gender identity:

Are they a veteran of the Military or disabled? (select all that apply):

Veteran

Disabled

Spouse of a deceased Veteran

Please describe their disability:

Sexual Identity/Sexual orientation:

Does this person provide household income?*

Yes

No

How much is this person's total income annually?*

Please include all sources of income such as Social Security, Supplemental Income, etc.

What is the name of the 4th additional person living in the home?*

What is their Date of Birth?*

Please ask them to provide their racial and ethnic identity by choosing one of the following options: (select all that apply):*

Gender identity:

Are they a veteran of the Military or disabled? (select all that apply):

Veteran

Disabled

Spouse of a deceased Veteran

Please describe their disability:

Sexual Identity/Sexual orientation:

Does this person provide household income?*

Yes

No

How much is this person's total income annually?*

Please include all sources of income such as Social Security, Supplemental Income, etc.

What is the name of the 5th additional person living in the home?*

What is their Date of Birth?*

Please ask them to provide their racial and ethnic identity by choosing one of the following options: (select all that apply):*

Gender identity:

Are they a veteran of the Military or disabled? (select both if applicable)

Veteran

Disabled

Spouse of a deceased Veteran

Please describe their disablity:

Sexual Identity/Sexual orientation:

Does this person provide household income?*

Yes

No

How much is this person's total income annually?*

Please include all sources of income such as Social Security, Supplemental Income, etc.

What is the name of the 6th additional person living in the home?*

If you have more than 6 people living in the home, please list out everyone else's information from this point on.

Relationship:*

Relationship to the Homeowner

What is their Date of Birth?*

Please ask them to provide their racial and ethnic identity:*

Please ask them to provide their gender identity:*

Are they a veteran of the Military or disabled?*

Please type N/A if not applicable.

Please ask them to provide their sexual identity:*

Please provide total income if applicable:*

Please include all sources of income such as Social Security, Supplemental Income, etc.

Household Income Data

PLEASE READ THE FOLLOWING REGARDING THE COLLECTION OF FINANCIAL DATA PRIOR TO FILLING OUT THE FORM ANY FURTHER.

Will County Habitat collects household income data from all members of the household to determine eligibility for our housing programs and services. This information is used to ensure that we are serving individuals and families who are in need of affordable housing and who meet certain income criteria.

We collect income information for the entire household, regardless of who is on title or deed, because eligibility for housing programs and services is based on the total income of the household. This includes all sources of income, such as wages, salaries, benefits, and investments. By collecting information on the entire household, we can accurately assess a household's financial situation and determine whether they are eligible for our programs and services.

All income information collected is kept confidential and used only for the purpose of determining eligibility and reporting in the aggregate. We take the privacy of our clients very seriously and we have policies and procedures in place to protect confidential information.

We will require additional verification of income on a periodic basis throughout the program to ensure that clients continue to meet eligibility requirements. This may involve requesting updated income documentation or conducting additional reviews to ensure that clients are still in need of affordable housing.

Collecting household income information helps us ensure that we are providing resources to those who need it most and helps ensure the sustainability of our programs and services. By keeping income information confidential and using it only for the intended purpose, we protect the privacy and dignity of our clients while providing critical support for those in need.

Primary Applicant

How many jobs do you currently have?*

1

2 or more

Who is your primary employer:*

The address of that organization:*

How much do they pay you?*

Who is your second employer?

If Applicable

The address of that organization:

How much do they pay you?

If you have more than 2 jobs, list all of the income together for all of those jobs. Please be sure to combine all sources of income for the same period, whether that is a week, a year, or something in between.

Social Security Income*

Supplemental Income (SSI)*

AFDC Income*

Child Support Income*

Disability Pension Income*

Pension or Retirement Income*

Interest Income*

Other Income*

2nd Co-Owner # of jobs*

1

2 or more

2nd Co-Owner primary employer:*

The address of that organization:*

How much are they paid?*

Who is their 2nd job with*

The address of that organization:*

How much are they paid*

If you have more than 2 jobs, list all of the income together for all of those jobs. Please be sure to combine all sources of income for the same period, whether that is a week, a year, or something in between.

Social Security Income*

Supplemental Income (SSI)*

AFDC Income*

Child Support Income*

Disability Pension Income*

Pension or Retirement Income*

Interest Income*

Other Income*

3rd Co-Owner # of jobs*

1

2 or more

3rd Co-Owner primary employer*

The address of that organization:*

How much are they paid?*

Who is their 2nd job with?

The address of that organization:

How much are they paid?

If you have more than 2 jobs, list all of the income together for all of those jobs. Please be sure to combine all sources of income for the same period, whether that is a week, a year, or something in between.

Social Security Income*

Supplemental Income (SSI)*

AFDC Income*

Child Support Income*

Disability Pension Income*

Pension or Retirement Income*

Interest Income*

Other Income*

Let's consider some adjustments to your income.*

Check if any of these apply

IRA Deductions amount*

Moving Expenses Amount*

Self Employment Tax Amount*

Health Insurance Amount*

Keogh & SEP plans*

Early Withdrawl*

Alimony paid*

Type of home*

Single family detached home

Condo or town-home

Cooperative

Mobile home

How many floors including basement, are in your home?*

First Floor

Second Floor

Basement

Amount owed*

Repairs Description

Please provide more details on the repairs needed

Thank you for your submission, this is a process

Thank you for taking the time to fill out the lengthy application form for Will County Habitat. We want to assure you that we have received your application and will be reviewing it in the coming week. If we need any additional information, we will reach out to you directly.

We want to remind you that if you are applying for home repair assistance or entering our homeownership program, this is not a quick process .

For home repairs, it typically takes about 30-60 days to get preliminary approval, followed by another 45 days to obtain all the final pricing and prepare the necessary agreements. Once the agreements are signed, you can expect work to begin between 30-60 days. All in all, the process could take 3-6 months before work begins.

Our homeownership program advancement is based upon loan readiness, which means that while some individuals come in ready to begin, most do not.

For those who are loan ready, they move onto the next stage of the process and begin sweat equity hours. Once 20% of the total required hours are completed, the opportunity to select the next available home becomes available and sweat equity hours accumulation continues towards homeownership. We want to be transparent with you and let you know that this process can take a year or more, depending on your individual situation. However, we are committed to providing affordable and safe housing for those in need in our community and will work with you every step of the way.

Thank you for considering Will County Habitat for your housing needs. We look forward to working with you towards achieving your goals!