August 2026 Initial Application

Please provide the following informtion for a quick and confidential financial review. All required fields must be completed for your application to be processed.

August 2026 Initial Homeownership Application

Prefix (Mr., Mrs., Ms., Dr., etc.)

First Name *

Last Name *

Email *

Gender

Date of Birth

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Applicant

Complete each field.

Last Name * The field Last Name is required.

First Name * The field First Name is required.

Middle Name * The field Middle Name is required.

Date of Birth * The date field Date of Birth is required.

Social Security Number * The numeric field Social Security Number is required.

Marital Status * The field Marital Status is required.

Street Address * The field Street Address is required.

City * The field City is required.

State * The field State is required.

Zip Code * The numeric field Zip Code is required.

County * The field County is required.

Contact Phone Number * The phone field Contact Phone Number is required.

Email * The email field Email is required.

Do you own a home? * The field Do you own a home? is required.

What is your race? * The field What is your race? is required.

What is your ethnicity?

Applicant Income

Complete each field.

Are you employed? * The field Are you employed? is required.

How long have you been at your current job? * The field How long have you been at your current job? is required.

How many hours per week do you work? * The numeric field How many hours per week do you work? is required.

What is your hourly wage? * The numeric field What is your hourly wage? is required.

Do you have any other sources of income? * The field Do you have any other sources of income? is required.

How much do you receive monthly in other source (s) of income? (SSDI, SSI, VA Benefit, Retirement, Child Support) * The numeric field How much do you receive monthly in other source (s) of income? (SSDI, SSI, VA Benefit, Retirement, Child Support) is required.

Co-Applicant

Complete each field.

Last Name * The field Last Name is required.

First Name * The field First Name is required.

Middle Name * The field Middle Name is required.

Date of Birth * The date field Date of Birth is required.

Social Security Number * The numeric field Social Security Number is required.

Marital Status * The field Marital Status is required.

Street Address * The field Street Address is required.

City * The field City is required.

State * The field State is required.

Zip Code * The numeric field Zip Code is required.

County * The field County is required.

Contact Phone Number * The phone field Contact Phone Number is required.

Email * The email field Email is required.

Do you own a home? * The field Do you own a home? is required.

What is your race? * The field What is your race? is required.

What is your ethnicity?

Co-Applicant Income

Complete each field.

Are you employed? * The field Are you employed? is required.

How long have you been at your current job? * The field How long have you been at your current job? is required.

How many hours per week do you work? * The numeric field How many hours per week do you work? is required.

What is your hourly wage? * The numeric field What is your hourly wage? is required.

Do you have any other sources of income? * The field Do you have any other sources of income? is required.

How much do you receive monthly in other source (s) of income? (SSDI, SSI, VA Benefit, Retirement, Child Support) * The numeric field How much do you receive monthly in other source (s) of income? (SSDI, SSI, VA Benefit, Retirement, Child Support) is required.

Household

Complete each field.

How many people will be living in the household? * The numeric field How many people will be living in the household? is required.

How many people under 18 will be living in the household? * The numeric field How many people under 18 will be living in the household? is required.

How many people over 65 will be living in the household? * The numeric field How many people over 65 will be living in the household? is required.

Have you lived in Jackson County for the last 12 months? * The field Have you lived in Jackson County for the last 12 months? is required.

Have you lived in Washington County for the last 12 months? * The field Have you lived in Washington County for the last 12 months? is required.

What is the household total monthly income from all sources? (Applicant, co-applicant, and other sources) * The numeric field What is the household total monthly income from all sources? (Applicant, co-applicant, and other sources) is required.

How did you hear about our Habitat Homeownership Program? The maximum length for the field How did you hear about our Habitat Homeownership Program? is 500 characters.

Authorization Release Information

I understand that the evaluation will include personal visits, a credit check, and employment verification. I have answered all the questions on this application truthfully. I understand that if I have not answered the questions truthfully, my application may be denied, and that even if I have already been selected to receive a Habitat home, I may be disqualified from the program and forfeit any rights or claims to a Habitat home. The original or a copy of this application will be retained by Habitat for Humanity even if the application is not approved.

I also understand that Chipola Area Habitat for Humanity screens all applicants on the sex offender registry. By completing this application, I am submitting myself to such an inquiry. I further understand that by completing this application, I am submitting myself to a criminal background check.

Applicant Agrees

Co-Applicant Agrees