Veteran’s Repair Assistance Program Pre-Qualification Form by Victoria McCallister | Sep 30, 2019 | VRAP Pre-qualifcation From | 0 comments 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. Applicant Name*Co-Applicant NameAddress*Co-Applicant AddressCity, State, Zip*Co-Applicant City, State, ZipNumber of years at current address*Co-Applicant Number of years at current addressPrevious address (if less than 2 years at current address)Co-Applicant Previous address (if less than 2 years at current address)Date of Birth*Co-Applicant Date of BirthGender* Male Female Co-Applicant Gender Male Female Home Phone Number*Cell Phone Number*Co-Applicant Cell Phone NumberMarital Status (check one)* Married Separated Unmarried (single, divorced, widowed) Co-Applicant Marital Status (check one) Married Separated Unmarried (single, divorced, widowed) Dependents and others who live with you:*Name, Date of Birth, Male/Female of each memberCo-Applicant Dependents and others who live with you:*Name, Date of Birth, Male/Female of each memberAre you a veteran?* Yes No Co-Applicant: Are you a veteran? Yes No Employer*Co-Applicant EmployerTitle/Position*Co-Applicant Title/PositionStart Date of your Employment*Co-Applicant: Start Date of your EmploymentPrevious Employer (required if not at current job for at least 2 years)*Co-Applicant Previous Employer (required if not at current job for at least 2 years)Start Date at previous employerCo-Applicant: Start Date at previous employerEnd Date at previous employerCo-Applicant: End Date at previous employerGross Monthly IncomeEmployment Income for Applicant*TANF Amount*Food Stamps*Social Security*SSI*Disability*Child Support*Other*Total Gross Monthly Income for Applicant*Monthly BillsMortgage*Utilities*Car Payment*Insurance*Child Care*Credit Card Payments*Alimony/Child Support*Student Loans*Please answer the following questionsHave you lived or worked in Allen, Huntington or Wells county for the last 12 months?* Yes No Are you current on your monthly mortgage payments?* Yes No Do you have a bankruptcy that has not been discharged/dismissed for at least 2 years?* Yes No Do you receive a Housing Choice Voucher?* Yes No Do you have deferred student loans?* Yes No Are you willing to contribute sweat equity hours by attending homeownership classe, working at the Habitat ReStore and construction site?* Yes No Are you willing to make any payment toward the repair of your home?* Yes No What school does your children currently attend? (please list school name & school system)*Do you currently have a homeowners insurance policy?* Yes No Please answer the following questions: strongly agree; agree; neutral/not applicable; disagree; strongly disagreeOur family feels safe in our current living situation.* Strongly Agree Agree Neutral/Not Applicable Disagree Strongly Disagree Our family is comfortable asking neighbors for help.* Strongly Agree Agree Neutral/Not Applicable Disagree Strongly Disagree Our family feels our financial future continues to improve.* Strongly Agree Agree Neutral/Not Applicable Disagree Strongly Disagree Our family currently spends quality time together.* Strongly Agree Agree Neutral/Not Applicable Disagree Strongly Disagree My children perform well in their current school.* Strongly Agree Agree Neutral/Not Applicable Disagree Strongly Disagree Our family is able to maintain good health overall.* Strongly Agree Agree Netutral/Not Applicable Disagree Strongly Disagree How did you hear about our Veteran's Repair Assistance Program?* Friend/Family Member Habitat Homeowner Veterans Connect Social Media Other Race/National OriginInformation 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. Race/National Origin* Hispanic Caucasian Black/African-American Asian Burmese American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Other Do not wish to answer Consent* By signing and submitting this questionaire, I/we request consideration for Habitat for Humanity's Veteran's Repair Assistance Program. I understand that my credit report will be used by Habitat for Humanity to help determine my eligibility.EmailThis field is for validation purposes and should be left unchanged. Submit a Comment Cancel replyYour email address will not be published. Required fields are marked *Comment Name * Email * Website This site uses Akismet to reduce spam. Learn how your comment data is processed.
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