Expression of Interest – Habitat for Humanity Grey Bruce

If you require clarification or assistance,

call our office at 519-371-6776, extension 101 and speak with Rachelle

or email info@habitatgreybruce.ca

Family Information for Expression of Interest

Name of Applicant *
Name of Co-applicant
Address *
Unit / Apt.
City / Town *
Postal
Number of years at address
Email
Re-Enter Email
Home Phone
Work Phone
Cell Phone
Number of children living at home
Ages of Children

Employment

Applicants Job / Occupation
Co-Applicants Job / Occupation
Name of Employer
Name of Employer
Number of years working there
Number of years working there
Employers Phone
Employers Phone

Current Accommodation

Describe your present home (number of bedrooms, condition etc.) and explain why your family needs a new home.
List the town / city where you prefer to live. You may list more than one.

Household Income

Monthly Gross (before deductions) Income from Employment

Applicant
Co-applicant
Other Adult 18+

Employment Insurance (E I)

Applicant
Co-applicant
Other Adult 18+

Contracted Child Support Received

Applicant
Co-applicant
Other Adult 18+

Contracted Spousal Support Received

Applicant
Co-applicant
Other Adult 18+

Child Tax Benefits

Applicant
Co-applicant
Other Adult 18+

Ontario Disability Support

Applicant
Co-applicant
Other Adult 18+

CPP or Other Pension Income

Applicant
Co-applicant
Other Adult 18+

Other Income

Applicant
Co-applicant
Other Adult 18+

Debt and Assets

Credit Card Balances

Applicant
Co-applicant
Other Adult 18+

Total Loans and Other Debts

Applicant
Co-applicant
Other Adult 18+

Total Assets

Applicant
Co-applicant
Other Adult 18+
Have you declared or been discharged from bankruptcy within the past 3 years? (required answer) *
YesNo

Other

List any additional comments about the information you have provided.

Verification

Please enter any two digits *Example: 12 By submitting this form you certify that you have answered all of the questions truthfully and to the best of your knowledge.
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