Initial Screening Form

Habitat for Humanity of Hillsborough County works to acquire affordable residential building lots throughout Hillsborough County. We are currently building homes in Plant City, Temple Terrace, East Tampa, the University Area and Wimauma. We build in these and other areas as land opportunities are available to us. **VETERANS ARE URGED TO APPLY THROUGH THE VETERANS INITIAL SCREENING FORM.**

To be eligible for this program, you must have lived OR worked in Hillsborough County for the last 12 consecutive months. It can be one or the other or both. You must also have steady, verifiable income from a job OR other sources. This can include disability pay or retirement pay.

Please provide the gender and ages of all those who will be living with you. DO NOT INCLUDE Applicant or Co-Applicant.

List your TOTAL GROSS MONTHLY INCOME FOR YOUR HOUSEHOLD, including the income from all those 18 and older WHO WILL BE LIVING IN THE HOME. Include income from these sources: Wages (before taxes and deductions), Social Security income, alimony, child support you receive, disability, and any other regular monthly income. Please list each different type of income along with the monthly amount:

By submitting this form, I affirm that the information on this form is true and correct. I understand that providing false information could cause me to be disqualified from the Habitat program. I authorize the verification of the information provided on this form as to my credit, employment, income and background, including criminal background checks. I have received a copy of this Initial Application. I understand that, based on the information I provided, if my Initial Application meets Habitat Hillsborough’s basic criteria, I will be invited to submit a full Homeownership Program application. If it does not meet basic criteria, I understand that I will receive an Adverse Action letter. Further, I acknowledge that if I am able to submit a Habitat Homeownership Program Application, and an appraisal is ordered in connection with that application, I will be provided a copy of that appraisal at no cost to me.