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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 please 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
*

First Name
Last Name
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
*



*

Co-Applicant
*

First Name
Last Name
*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
*



*


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.
CURRENT HOUSING INFORMATION




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


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


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code




Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code




Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code




Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code




Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code


Co-Applicant


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code




Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code




Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code


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.
*

Enter first and last name.
*


Enter first and last name.