pre-qualification questionnaire

This is a pre-screening questionnaire, not a final application for homeownership.
This form is to help determine if the Habitat for Humanity program might be right for your household. It is one step in the process of applying for a home.

Please note: After submitting the form, please allow up to four weeks for the process of this application and they will receive a response back by email. Be sure to check your spam folder.

Equal Housing Opportunity: We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status or national origin.

Applicant Information


If not applicable write "None"
Co-applicant Information


Have you lived or worked in Pinellas County for at least one (1) year? *

Have you had verifiable and continuous income for at least 1 year? *

Have you ever filed for bankruptcy? *

Monthly Income

List your total monthly income from applicant and co-applicant, 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, alimony, child support, disability, any other regular monthly income. Please list each different type of income along with the monthly amount:

(what you earn monthly before taxes/deductions)
Monthly Expenses

List your monthly expenses, including court ordered payments, minimum monthly credit card payments for all credit cards combined, car payments, insurance, child care and minimum payments for all loans such as furniture or student loans, or any other debts (do not include utilities).

Do you have any collections? *

Give us an estimate of the amounts

(Do not include co-applicant in this section)
Are you willing to make a commitment to the Habitat program, which requires that homeowner candidates earn sweat equity hours and attend a series of homeownership classes? *

How Did You Find Habitat?
Sexual Predator List
Are you on the sexual predator list or have you had a drug trafficking conviction in the last 3 years? *


By submitting this form, I affirm that the information on this form is true. I understand that providing false information could cause me to be disqualified from the Habitat program. I understand that someone from Habitat for Humanity will contact me with the results from this questionnaire, and that I may be invited to complete a homeowner application.