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*
MM slash DD slash YYYY
Social Security #*
Co-Applicant Info
Name
First Middle Last
Address
Street Address City State ZIP Code
Phone
Email
Date of Birth
MM slash DD slash YYYY
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
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 Race
- American Indian or Alaska Native (Enter name of enrolled or principal tribe below)
- Asian
- Asian (Asian Indian)
- Asian (Chinese)
- Asian (Filipino)
- Asian (Japanese)
- Asian (Korean)
- Asian (Vietnamese)
- Asian (Other - Enter race in field below)
- Black or African American
- Native Hawaiian or Other Pacific Islander
- Native Hawaiian or Other Pacific Islander (Native Hawaiian)
- Native Hawaiian or Other Pacific Islander (Guamanian or Chamorro)
- Native Hawaiian or Other Pacific Islander (Samoan)
- Native Hawaiian or Other Pacific Islander (Other - Enter race in field below)
- White
- I do not wish to provide this information
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
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 Race
- American Indian or Alaska Native (Enter name of enrolled or principal tribe below)
- Asian
- Asian (Asian Indian)
- Asian (Chinese)
- Asian (Filipino)
- Asian (Japanese)
- Asian (Korean)
- Asian (Vietnamese)
- Asian (Other - Enter race in field below)
- Black or African American
- Native Hawaiian or Other Pacific Islander
- Native Hawaiian or Other Pacific Islander (Native Hawaiian)
- Native Hawaiian or Other Pacific Islander (Guamanian or Chamorro)
- Native Hawaiian or Other Pacific Islander (Samoan)
- Native Hawaiian or Other Pacific Islander (Other - Enter race in field below)
- White
- I do not wish to provide this information
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

Primary Applicant Info

Co-Applicant Info

Other Information

Total Monthly Income from Each of the Following Sources

Qualification Questions

Demographic Information

Authorization