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Interested in becoming a Habitat Homeowner
Complete the application to submit your interest.
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)
*
Yes
No
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.
This box is for spam protection -
please leave it blank
:
Click here for a printable Expression of Interest Form
If you require clarification or assistance,
call our office at 519-371-6776, extension 101 and speak with our Business Manager
or email info@habitatgreybruce.ca
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