Habitat Office: 203.744.1340 | ReStore: 203.205.0952

FAMILY SELECTION PRESCREEN FORM

Fill out our short-form application. Once this screening for income-qualified applicants is completed, we will send you our formal application.

Family / Applicants:
Phone:
E-mail:
Property / location applying for:
Current housing needs (summarize why the applicant's current housing situation is inadequate - size, location, safety, etc.):
Total estimated current yearly household income: $
Number of family members in household:

Job stability (time in current job):

Applicant:
Co-Applicant:
Please note any substantial past due or collection items:
Has anyone had any prior property foreclosures?
Do you own any other property?
Form Verification