Building a Better Community Through Affordable Home Ownership

Prospective Homeowner Screening Form

If you are interested in owning a Habitat home, please complete the following questions. Your answers will help Habitat for Humanity of Northern Virginia (Habitat NOVA) determine your eligibility for a Habitat home. If you need assistance when completing this questionnaire, please call Jennifer Schroeder at (703) 521-9890, ext 107. All information gathered by Habitat NOVA is considered confidential and will only be used for our Family Selection Process.

PLEASE NOTE: COMPLETING THIS QUESTIONNAIRE DOES NOT GUARANTEE THAT YOU WILL GET A HABITAT HOME. IT IS TO DETERMINE ELIGIBILITY ONLY. ALL QUESTIONS MUST BE ANSWERED COMPLETELY. INCOMPLETE FORMS WILL RECEIVE AN ‘INELIGIBLE’ MESSAGE AFTER THEY ARE SUBMITTED.









How many adults (18 and over) are in your household?*

How many children are in your household?*

What is your combined annual income (before taxes)?*

How much do you pay each month for rent?*

I/we have lived for at least one year in:*

I/we am/are U.S. Citizens or have Legal Permanent Resident Status:*

I/we understand the Sweat Equity requirement and am/are willing to partner with HFHNV:*

I/we understand that I/we must pay a down payment of 1% of the final sale price of the home, due at closing:*

I/we are responsible about paying our bills and I/we have not filed for bankruptcy in the past two years:*

I/we understand that I/we am/are applying for a homeownership program offered by HFHNV. I/we am/are prepared to make monthly mortgage payments:*

I/we understand that prior to being selected for homeownership, HFHNV will conduct background criminal and credit checks, as well as employment verification:*

I/we am/are veterans of the U.S. armed services or currently on active duty with the U.S. armed services:*

If you have not received an email response to this questionnaire within 24 hours please contact Habitat NOVA directly at 703-521-9890 or info@habitatnova.org.