One moment please...
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
*

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.
*
Check "yes" if you (applicant and co-applicant) agree.
CURRENT HOUSING INFORMATION




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

*
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


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.