P.O. Box 1525/ 115 E.

DeKalb ST Suite 5A, Camden, SC 29020

(803) 432-4333 (ph) (803) 432-4325 (fax)

Habitat for Humanity of Kershaw County

HHKC Official
Homeownership Application
Package – C2012

Full and complete PRACTICE

applications must have been RECEIVED
in the Habitat Office by the date & time
shown below.

27 January 2012
12:00 NOON

Late applications WILL NOT be Accepted.

DO NOT REMOVE THIS PAGE

Dear Applicant: This application must be completed to determine if you qualify for a house
through Habitat for Humanity. Fill it out as completely and accurately as possible. All information
you include on this document will be kept confidential.

1. Applicant Information
Applicant Information Co-Applicant Information
First Name Middle Initial Last Name First Name Middle Initial Last Name

Male Female Male Female

Social Security Number: Social Security Number:

Date of Birth (mm/dd/yyyy): Date of Birth (mm/dd/yyyy):

/ / / /
Home and/or Cell Phone Number: Home and/or Cell Phone Number:

Work Phone Number: Work Phone Number:

Email: Email:

Married Single Married Single

*Please note if applicant is married but plans to apply to .

Habitat as a single person, their divorce must be finalized
before we can consider the application.
Present Address: Present Address:

Street Address Street Address

City State Zip Code City State Zip Code

Number of years at this address: Number of years at this address:

Household Occupants
List the names and date of birth for all occupants who will be living in the house. Do not include the Applicant and the Co-
Applicant. IMPORTANT: All occupants listed must currently be living with the Applicant. If special circumstances exists, please explain below.
Date of Birth
Name (First and Last) Age Relationship to Applicant(s)
(mm/dd/yyyy)

Explanation(s):
 If Living at Present Address for Less Than Two (2) Years, Complete the Following:
Applicant Co-Applicant
Former Address: Former Address:

Street Street

City State Zip Code City State Zip Code

Number of years at this address: Number of years at this address:

2. Present Housing Conditions

This is a REQUIRED part of your application. We WILL NOT review applications without this information filled in.
Number of Bedrooms:
Total Number of People in Current Housing: ____________
Number of Bathrooms:

Applicant(s) must have a demonstrated need for simple, decent, affordable housing. Use the space below to provide the
Application Review Committee with information about your current housing situation. Indicate all problems, challenges, or
hardships. Your Housing Need will be further evaluated by a home visit for assesment purposes.
 3. Willingness to Partner
Applicant Co-Applicant
To be considered for a Habitat home, you and your family, must be willing to complete 175 -300 “sweat equity” hours.
Your help in building your house and the homes of others is called “sweat equity” and may include clearing the lot,
painting, helping with construction, working in the Habitat ReStore - or office - or other approved activities.

I am willing to complete the required “sweat I am willing to complete the required “sweat
equity” hours. equity” hours.

4. Employment Information
Applicant Co-Applicant

Check this box if you are self employed. Check this box if you are self employed.
Name of Current Employer: Name of Current Employer:

Position/ Title: Position/ Title:

Employement Dates: Employement Dates:

From: ___________________ To: ___________________ From: ___________________ To: ___________________
(month/year) (month/year) (month/year) (month/year)
Address of Employer: Address of Employer:

Street Street

City State Zip Code City State Zip Code

Monthly Gross Income (Before Taxes): $ Monthly Gross Income (Before Taxes) : $

If you currently have more than one (1) job, please complete the next section

Applicant Co-Applicant

Check this box if you are self employed. Check this box if you are self employed.
Name of Current Employer: Name of Current Employer:

Position/ Title: Position/ Title:

Employement Dates: Employement Dates:

From: ___________________ To: ___________________ From: ___________________ To: ___________________
(month/year) (month/year) (month/year) (month/year)
Address of Employer: Address of Employer:

Street Street

City State Zip Code City State Zip Code

Monthly Gross Income (Before Taxes) : $ Monthly Gross Income (Before Taxes) : $
 If working at present job for less than one (1) year, complete the following
Applicant Co-Applicant

Check this box if you are self employed. Check this box if you are self employed.
Name of Current Employer: Name of Current Employer:

Position/ Title: Position/ Title:

Employement Dates: Employement Dates:

From: ___________________ To: ___________________ From: ___________________ To: ___________________
(month/year) (month/year) (month/year) (month/year)
Address of Employer: Address of Employer:

Street Street
City State Zip Code City State Zip Code

Monthly Gross Income (Before Taxes): $ Monthly Gross Income (Before Taxes) : $

IMPORTANT NOTICE:

If At Any Time During The Application Process

Habitat For Humanity Of Kershaw County
Discovers Undeclared Income By Any Of The
Applicants, Co-Applicants, Or Family Members,
That Will Be Grounds For Application Denial.

5a. Financial Information – Monthly Household Income

Applicant Co-Applicant
1. Gross Monthly Wages (Before Taxes): 1. Gross Monthly Wages (Before Taxes):

2. Social Security Income: 2. Social Security Income:

3. Child Support (Monthly amount & how long you expect to receive it): 3. Child Support (Monthly amount & how long you expect to receive it):

4. Alimony 4. Alimony

5. Other (Please specify –AFDC/TANF, Food Stamps etc.): 5. Other (Please specify –AFDC/TANF, Food Stamps etc.):

Total Monthly Income: Total Monthly Income:

(1+2+3+4+5) $ A (1+2+3+4+5) $ B
Other Household Member #1 (18 Years or older) Other Household Member #2 (18 Years or older)
Name: Name:

Age: Age:

Relationship: Relationship:
1. Gross Monthly Wages (Before Taxes): 1. Gross Monthly Wages (Before Taxes):

2. Social Security Income: 2. Social Security Income:

3. Child Support (Monthly amount & how long you expect to receive it): 3. Child Support (Monthly amount & how long you expect to receive it):

4. Alimony 4. Alimony

5. Other (Please specify –AFDC/TANF, Food Stamps etc.): 5. Other (Please specify –AFDC/TANF, Food Stamps etc.):

Total Monthly Income: Total Monthly Income:

$ $
(1+2+3+4+5) C (1+2+3+4+5) D

Total Household Monthly Income: $ (A+B+C+D)

You must provide official documentation of all sources of income.

(Check stubs, Employer Computer Print-out, DSS Print-outs, Social Security Print-outs, Written
Evidence of Income, Etc. )

5b. Financial Information – Monthly Household Expenses

Expense Monthly Payment Debt Monthly Payment
Rent: Car Payment
Total Utilities: Credit Card #1:
Child Care: Credit Card #2:
Phone: Credit Card #3:
Other Credit Cards
Cell Phone:
Total:
Cable/ Satellite: Furniture:
School Lunch: Appliances:
Auto Insurance: Student Loan(s):
Other: Hospital / Medical:
Other Loans (Please
Other:
Specify):
Other: Child Support:
Other: Alimony:

Total Monthly $ Total Monthly $

Expenses: Expenses:

IMPORTANT: Section 5c MUST BE completed as

thoroughly as possible.
 5c. Debt Listing
List below all payments, of any kind (medical, car furniture, debt consolidation loans, dental, hospital,
etc.) Though you have completed section 5a & 5b, this is where you identify All outstanding debts.
Information in this section is important to a complete evaluation of your application.

Businesses or People you Amount of Monthly Number of

Account #: Unpaid Balance:
owe money to: Payment: Payments Left:

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

_____________________ __________ ________________ _______________ ____________

 6. Financial Assests – Bank Account(s) and Property Information
Applicant Co-Applicant
Total Number of Checking Accounts: _________________ Total Number of Checking Accounts: _________________
Total Number of Savings Accounts: _________________ Total Number of Savings Accounts: _________________
Total Number of Other Type Accounts: _________________ Total Number of Other Type Accounts: _________________
Please Provide specific bank account information for ALL Please Provide specific bank account information for ALL
accounts in the space provided below. accounts in the space provided below.
Bank Account(s) Information Bank Account(s) Information
Name of Bank: ____________________________ Name of Bank: ____________________________
Account Number: ____________________________ Account Number: ____________________________
Type of Account: ____________________________ Type of Account: ____________________________
Avg. Monthly Balance: ____________________________ Avg. Monthly Balance: ____________________________

Check if Joint Account with Co-Applicant Check if Joint Account with Applicant
Name of Bank: ____________________________ Name of Bank: ____________________________
Account Number: ____________________________ Account Number: ____________________________
Type of Account: ____________________________ Type of Account: ____________________________
Avg. Monthly Balance: ____________________________ Avg. Monthly Balance: ____________________________

Check if Joint Account with Co-Applicant Check if Joint Account with Applicant
Name of Bank: ____________________________ Name of Bank: ____________________________
Account Number: ____________________________ Account Number: ____________________________
Type of Account: ____________________________ Type of Account: ____________________________
Avg. Monthly Balance: ____________________________ Avg. Monthly Balance: ____________________________

Check if Joint Account with Co-Applicant Check if Joint Account with Applicant
Property Information Property Information
Do you own property? Do you own property?
Yes No Yes No

If Yes- If Yes-
What is your monthly Payment: _____________________ What is your monthly Payment: _____________________
What is your Unpaid Balance: _____________________ What is your Unpaid Balance: _____________________

Address: ________________________________ Address: ________________________________

________________________________ ________________________________

Type of Property: Type of Property:

House/Condo House/Condo

Land Land

Other: (specify) _______________ Other: (specify) _______________

7. Down Payment and Closing Cost Information

All Habitat for Humanity of Kershaw County home buyers must pay a $500.00 down payment. Where will you get this
money from (example; savings, parents, etc.) ? If you are borrowing money to pay this cost, explain how and from whom.
 8. Declarations
Applicant Co-Applicant
Please Check the box that best answers the following questions.
A. Do you have any debt A. Do you have any debt
because of a court decision Yes No because of a court decision Yes No
against you (i.e. tax lien, against you (i.e. tax lien,
judgement, etc.): judgement, etc.):
B. Have you declared B. Have you declared
bankruptcy within the past 7 Yes No bankruptcy within the past 7 Yes No
years? years?
C. Have you had property C. Have you had property
foreclosed on within the Yes No foreclosed on within the Yes No
past 7 years? past 7 years?
D. Have you been convicted D. Have you been convicted
of a drug related offense Yes No of a drug related offense Yes No
within the last 5 years? within the last 5 years?

Answering “Yes” to these questions does not automatically disqualify you. If you
answered “Yes” to any questions A-D, however, explain in the space provided below.
E. Have you ever been convicted of a sexual offense? E. Have you ever been convicted of a sexual offense?

Yes No Yes No

Conviction of a sexual offense is grounds for application denial.

F. Are you a legal, permanent resident of the U.S. or U.S. F. Are you a legal, permanent resident of the U.S. or U.S.
Citizen? Citizen?

Yes No Yes No

Additional Information on Items A-D Additional Information on Items A-D

 9. Authorizations
Authorization #1:
I / We understand that by filing this application, I am authorizing Habitat for Humanity of Kershaw County to evaluate
my actual need for a Habitat home, my ability to repay the no-interest loan and other expenses of homeownership, and
my willingness to be a partner family. I understand that the evaluation will include personal visits, a credit check,
employment verification, and a criminal record background check. I have answered all the questions on this application
truthfully. I understand that if I have not answered the questions truthfully, my application may be denied, and that
even if I have already been selected to receive a Habitat home, I may be disqualified from the program. The orginal, or a
copy, of this application will be retained by Habitat for Humanity of Kershaw County even if the application is not
approved.

Authorization #2:
I / We understand that Habitat for Humanity screens all potential staff (whether paid or unpaid), board members, and
applicant families on the sex offender registry. By completing this application, I am submitting to such an inquiry.

Authorization #3:
I / We the undersigned, by the execution of the attached consent form grant Habitat for Humanity of Kershaw County
permission to do a credit check for the Applicant and Co-Applicant as a part of the financial evaluation.

Authorization #4:
I / We the undersigned, by the execution of the attached consent form grant Habitat for Humanity of Kershaw County
permission to do a criminal background check upon the tentative selection of the applicant(s) as a Habitat for Humanity
home buyer.
Applicant Co-Applicant

Printed Name Printed Name

Social Security Number: Social Security Number:

Signature Date Signature Date

Occupant 18 Years or Older Occupant 18 Years or Older

Printed Name Printed Name

Social Security Number: Social Security Number:

Signature Date Signature Date

Occupant 18 Years or Older Occupant 18 Years or Older

Printed Name Printed Name

Social Security Number: Social Security Number:

Signature Date Signature Date

 10. Consent to Criminal Background Check
Applicant
I ______________________________________, an
(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature
Occupant 18 Years or Older
I ______________________________________, an
(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature
Occupant 18 Years or Older
I ______________________________________, an
(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature
11.Credit Report Authorization
Applicant
I ______________________________________, hereby
(Printed Name)
authorize Habitat for Humanity of Kershaw County to
request credit reports on my behalf from any and all credit
bureaus. This action Is in direct relation to the review of my
application for homeownership.
Signed and dated this _______day of _____________, 201__
Signature
Co-Applicant
I ______________________________________, an
(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature
Occupant 18 Years or Older
I ______________________________________, an
(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature
Occupant 18 Years or Older
I ______________________________________, an
(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature
Co-Applicant
I ______________________________________, hereby
(Printed Name)
authorize Habitat for Humanity of Kershaw County to
request credit reports on my behalf from any and all credit
bureaus. This action Is in direct relation to the review of my
application for homeownership.
Signed and dated this _______day of _____________, 201__
Signature
 You must submit a $25.00 fee with your application. If Habitat does not receive the fee, your
application will not be reviewed.
YOUR APPLICATION MUST INCLUDE A CASHIERS CHECK OR MONEY ORDER
PAYABLE TO: Habitat for Humanity of Kershaw County
**Fee is for background and credit check.**
***No cash or personal checks are accepted.***

Equal Housing Opportunity

We Pledge 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 nation origin.

12. For Office Use Only – DO NOT WRITE IN THIS SPACE

Date Received: _______________________ Date Letter Sent: _____________________________

More information requested? Date of Home Visit: _____________________________

Yes No Date Letter Sent: _____________________________

Date Application Completed: _______________________

Accepted Denied