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A Brush With Kindness Application

We appreciate your interest in our A Brush With Kindness program. Please read each question carefully and answer honestly.

Some sections contain duplicate areas for applicant and co-applicant, so pay careful attention to your entries.

Your application will be reviewed and someone will be in contact with you as soon as possible.

CONTACT INFORMATION

Applicant

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Co-Applicant

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Name - Age - Gender - SSN (if over 18)

To be considered for Habitat’s ABWK home preservation program you and your family must be willing to complete a certain number of “sweat-equity” hours. Your help in revitalizing your home and the homes of others is called “sweat-equity” and may include clearing the lot, painting, helping with construction, or other approved activities.
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Check "yes" if you (applicant and co-applicant) agree.

CURRENT HOUSING INFORMATION





Please note if this is monthly, quarterly, annually, etc.

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Please select from the following options to indicate where repairs are needed.

EMPLOYMENT INFORMATION AND OTHER INCOME

Applicant






Please list sources and the amount.

Co-Applicant






Please list sources and the amount.

DEBT INFORMATION

Applicant


Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Co-Applicant


Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

Monthly Payment & Unpaid Balance

ASSET INFORMATION

Please complete a different entry for each asset.

Applicant
















Co-Applicant










DECLARATIONS

Please answer the following questions.

Applicant


Co-Applicant


AUTHORIZATION AND RELEASE

I understand by filling this application, I am authorizing Habitat for Humanity to evaluate my actual need for the A Brush with Kindness home preservation program, and my willingness to be a partner through sweat equity. I understand that the evaluation will include personal visits, a credit check and employment verification may be denied, and that even if I have already been selected to receive home repairs through A Brush with Kindness program, I may be disqualified from the program. The original copy of this application will be retained by Habitat for Humanity even if the application is not approved.

I also understand that Habitat for Humanity screens all applicant families on the sex offender registry. By completing this application, I am submitting myself to such an inquiry. I further understand that by completing this application I am submitting myself to a criminal background check.
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Enter first and last name.
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Enter first and last name.