Homeownership Program Intake Form
Personal Information
IMPORTANT: If you list more than one adult in your household (who is not a dependent), then you must also list that person as your co-applicant.
Application Campaign
Year of Application
Application Stage of Application
Please select...
Submitted
Application Name
Primary Contact Lookup
Applying as:
Please select...
Single
Joint
Today's Date
Applicant
First Name
Last Name
Social Security Number
Date of Birth
Marital Status
Please select...
Married
Legally Separated
Unmarried (incl. single, divorced, windowed)
Citizenship Status
Please select...
US Citizen
Permanent Resident
DACA
Other
Other status description:
Mobile Phone Number
Home Phone
Email
Date Moved to Greater Teton Area
Do you currently own or have you owned real estate in the last three years?
Yes
No
Have you previously applied for a Habitat home?
Yes
No
Years previously applied (approximately)
Example: 2016, 2014
Co-Applicant
First Name
Last Name
Social Security Number
Date of Birth
Marital Status
Please select...
Married
Legally Separated
Unmarried (incl. single, divorced, windowed)
Citizenship Status
Please select...
US Citizen
Permanent Resident
DACA
Other
Other status description:
Mobile Phone Number
Home Phone
Email
Date Moved to Greater Teton Area
Do you currently own or have you owned real estate in the last three years?
Yes
No
Have you previously applied for a Habitat home?
Yes
No
Years previously applied (approximately)
Example: 2016, 2014
Dependents of the Household
Dependents and others who would be living in the Habitat house with applicant(s):
Number of Adults In Household
ex:1 or 2
I have dependents
I don't have any dependents
Dependents 0–18
ex. 0 or 4
Dependents 18–64
ex. 0 or 1
Dependents 65+
ex. 0 or 2
Employment Information
Please provide two full years of employment history.
Employment Details
Employment of:
Please select...
Applicant
Co-Applicant
Employment Status
Please select...
Current Employer
Secondary Employer
Previous Employer
Position
Type of employment (check all that apply)
Primary employment
Secondary employment
Permanent, year-round employment
Seasonal employment
Temporary employment
For seasonal or temporary work, what months are you employed?
Name of Employer
Manager's Name
Manager's Phone Number
Manager's Email
Start Date (Approximate)
End of Employment Date (Approximate)
Annual Salary (pre-tax amount)
$
Average # of hours worked per week in Teton County
accepted range 0 to 80 hours
Does Habitat have your permission to contact this employer to verify the employment information listed on this application?
I give my permission
I do not give my permission
If permission not given, please explain.
Employment Application
Contact Information