Credit Check Form – Habitat for Humanity of Evansville

Primary Applicant Info

Name*

First Middle Last

Address*

Street City State Zip Code

Phone*

Email*

Date of Birth*

Social Security #*

Co-Applicant Info

Name

First Middle Last

Address

Street Address City State ZIP Code

Phone

Email

Date of Birth

Social Security #

Other Information

Number of People in Household Age 18+ (Include Yourself)

Number of People in Household Age Under 18

Hidden

Number of People Who Will Live in the Home*

Total Monthly Income from Each of the Following Sources

Applicant

Wages

provide 2 most recent paystubs

Paystub 1*

Max. file size: 25 MB.

Paystub 2*

Max. file size: 25 MB.

Social Security Income

provide Social Security award letter

SSI Award Letter*

Max. file size: 25 MB.

SNAP/Food Stamps

provide SNAP Award Document

SNAP/Food Stamps Award Letter*

Max. file size: 25 MB.

Child Support

provide Child Support Court Order & Child Support payment history

Child Support Order*

Max. file size: 25 MB.

Child Support Payment History*

Max. file size: 25 MB.

Section 8 Housing

provide Sect. 8 Housing Voucher Program Award Letter

Sect. 8 Award Letter*

Max. file size: 25 MB.

Co-applicant

Co-applicant Wages

provide 2 most recent paystubs

Co-applicant Paystub 1*

Max. file size: 25 MB.

Co-applicant Paystub 2*

Max. file size: 25 MB.

Co-applicant Social Security Income

Provide Social Security Award Letter

Co-applicant SSI Award Letter*

Max. file size: 512 MB.

Co-applicant SNAP/Food Stamps

provide SNAP Award Document

Co-applicant SNAP/ Food Stamps Award Document*

Max. file size: 25 MB.

Co-applicant Child Support

provide child support court order and child support payment history

Co-applicant Child Support Order*

Max. file size: 25 MB.

Co-applicant Child Support Payment History*

Max. file size: 25 MB.

Co-applicant Section 8 Housing

provide sect. 8 housing voucher program award letter

Sect. 8 Award Letter*

Max. file size: 25 MB.

TOTAL MONTHLY INCOME*

You must provide proof of income for the applicant and co applicant (if applicable) either by uploading the document requested or delivering it to the Habitat office with your Credit Check Form.

Qualification Questions

Have you had dependable income for at least 1 year (i.e. wages, social security)?*

Have you been discharged form bankruptcy within the last 4 years?*

Have you had a felony conviction in the past 7 years?*

If there are extenuating circumstances you want to share, please use the field below.

Demographic Information

The purpose of collecting this information is to help ensure that all applicants are being treated fairly, that the housing needs of communities and neighborhoods are being fulfilled, and to otherwise evaluate our programs and report to our funders. For residential mortgage lending, Federal law requires we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to provide this information but are encouraged to do so. You may select one or more designations for “Ethnicity” and one or more designations for “Race.” The law provides that we may not discriminate on the basis of this information or on whether you choose to provide it. The law provide that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information please check below.

Applicant Ethnicity

Hispanic or Latino
Hispanic or Latino (Mexican)
Hispanic or Latino (Puerto Rican)
Hispanic or Latino (Cuban)
Hispanic or Latino (Other - Type Origin in field below)
Not Hispanic or Latino
I do not wish to provide this information

Applicant Ethnicity Origin

Origin - For example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

Applicant Sex

Untitled

Applicant Race

Applicant Tribe

American Indian or Alaskan Native - Name of enrolled or principal tribe.

Applicant Other Asian

Other Asian Race - for example: Hmong, Laotian, Thai, Pakistani, Cambodian and so on.

Applicant Other Pacific Islander

Other Pacific Islander Race - for example: Fijian, Tongan, and so on.

Co-applicant Ethnicity

Hispanic or Latino
Hispanic or Latino (Mexican)
Hispanic or Latino (Puerto Rican)
Hispanic or Latino (Cuban)
Hispanic or Latino (Other - Type Origin in field below)
Not Hispanic or Latino
I do not wish to provide this information

Co-applicant Ethnicity Origin

Origin - For example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

Co-applicant Sex

Co-Applicant Sex

Co-applicant Race

Co-applicant Tribe

American Indian or Alaskan Native - Name of enrolled or principal tribe.

Co-applicant Other Asian

Other Asian Race - for example: Hmong, Laotian, Thai, Pakistani, Cambodian and so on.

Co-applicant Other Pacific Islander

Other Pacific Islander Race - for example: Fijian, Tongan, and so on.

Authorization

Applicant Authorize Signature*

Applicant: I understand that by completing and signing this form, I am authorizing Habitat for Humanity of Evansville, Inc. to perform a credit check, criminal background check, and sex offender registry check. I am also acknowledging that I have received the Habitat Privacy Policy

Applicant - Please Type Your Name To Submit Credit Application*

Co-App Authorization

Co-Applicant: I understand that by completing and signing this form, I am authorizing Habitat for Humanity of Evansville, Inc. to perform a credit check, criminal background check, and sex offender registry check. I am also acknowledging that I have received the Habitat Privacy Policy.

Co-Applicant - Please Type Your Name To Submit Credit Application*

How did you hear about us?

560 E. Diamond Ave, Evansville, IN 47711 ph: (812)-423-5623 evansvillehabitat.org