Veteran's Repair Assistance Program Pre- Qualification Form

Please submit all required information below. Once submitted, Habitat will send you a letter within 30 days.
  • Name, Date of Birth, Male/Female of each member
  • Name, Date of Birth, Male/Female of each member
  • Gross Monthly Income

  • Monthly Bills

  • Please answer the following questions

  • Please answer the following questions: strongly agree; agree; neutral/not applicable; disagree; strongly disagree

  • Race/National Origin

    Information is for organizational records only. Habitat is an equal opportunity housing organization and does not discriminate against race, color, religion, sex, handicap, familial status or national origin.
  • This field is for validation purposes and should be left unchanged.