Apply For Home

Lakeland Habitat appreciates your giving to build homes for those in need. You are changing lives one house at a time!

APPLICATION

Prospective Homeowners Letter-Click Here to Read...

Return Application to:  Lakeland Habitat for Humanity, 1317 George Jenkins Blvd., Lakeland, FL 33815.
If you need help in filling out, call 682-3812.  Office hours are Monday through Friday 8:30a.m. to 5:00p.m.

Lakeland Habitat for Humanity, Inc. is an equal Housing Opportunity agency that does not discriminate against race, sex, religion, color, age or familial status.
Name

(Applicant)

 SS#
Name

(Co-Applicant)

 SS#
Marital Status: Married Unmarried Single
How Long?
Applicant’s Date of Birth: Co-Applicants Date of Birth:
Address: Apartment #:
City, State, Zip
Home Phone Work Phone Message Phone
How long have you lived at this address?
Children at Home:
  Name DOB Sex   Name DOB Sex
1. 1.
2. 2.
3. 3.
Others Living with You:
  Name Age Sex Relationship
1.
2.
Present Housing Situation:

House Duplex Apartment Other

Owned RentedNumber of Bedrooms 1 2 3 4 5

Other Rooms: Kitchen Bathroom Living Room Dining Room
If renting, how much is your monthly rent? $
Landlord’s Name Phone
Address
How would you describe the condition of the place in which you are now living?
Monthly Utility Payments:

Gas $ Electricity $ Heating oil $

Water $ Telephone $

 
Previous Address How long?
Previous Landlord’s Name Rent $
Previous Landlord’s Address Phone
 
Employment: Please give the following employment information for each applicant and working child.
Family Member
Name & Address of Present employer
Job Title Length of Employment
Gross Weekly Income $
Family Member
Name & Address of Present employer
Job Title Length of Employment
Gross Weekly Income $
Previous Employer How long?
Address Phone
Previous Employer How long?
Address Phone
 
Please list other income: (Including child support, food stamps, AFDC, Social Security, SSI, Disability, etc.)
  Name Type of Income Amount each month
1. $
2. $
3. $
Savings Account? If yes, what bank & how much
Checking Account? If yes, what bank & how much
Do you own land? Where is it?
Do you own a car? Year Make Model Condition
To whom does your family owe money?
  Company For what? Monthly Payment Balance Owned
1. $ $
2. $ $
3. $ $
Special Expenses:      Monthly Amount
Child care $ Child Support $
Medical $ Other (specify) $
Insurance $Other (specify) $
 
How many people will be living with you?
 

WILLINGNESS TO PARTNER
Why would you be a good Habitat homeowner?

Where did you obtain this application?
Have you ever been arrested or convicted of a crime?
(Conviction will not necessarily disqualify you)
Yes No
Why?
When?
 
Please explain if there are any special or unusual circumstances that you feel we should be aware of.
 

RELEASE FORM
 
The applicant(s) understand and authorize Lakeland Habitat for Humanity, Inc. to perform an in-depth study to determine applicant’s actual need and ability to pay homeowner expenses.  The investigation may include personal visits, a credit check, criminal record check and reference check.  If I am selected I will also be willing to work with the Family Support committee and the Family Services Coordinator in order to prepare myself to become a homeowner.
 
 

I hereby declare that the statements made in this application are true to the best of my knowledge.
Applicant Co-Applicant
 
Date