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How to Apply

Roofs, Ramps & Repairs Online Questionnaire


** Notice to applicants** We are not undertaking roof projects at this time.


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Do you have an interest in the West Pasco Habitat for Humanity's Roofs, Ramps & Repairs Program?

Please complete the pre-qualification form below to see if the West Pasco Habitat for Humanity's Roofs, Ramps & Repairs Program is right for you. Once submitted, someone from Habitat will contact you with the results and may invite you to complete a Roofs, Ramps & Repairs Application.

First Name
Middle Initial/Name
Last Name
*If not applicable write N/A
First Name
Middle Initial/Name
Last Name
*If not applicable write N/A
Country
Address Line 1
Address Line 2
City
State
Postal Code
If your mailing address is different, please enter it here.
Country
Address Line 1
Address Line 2
City
State
Postal Code
Please provide the best number to contact you.
Phone Number
ext Extension
Are you the owner of record?
Have you had verifiable, steady income for at least one (1) year?
To prequalify you and your co-applicant must not have any bankruptcies, foreclosures or repossessions within the last seven (7) years.
Have you or your co-applicant filed for bankruptcy in the last seven (7) years?:
Have you or your co-applicant had any repossession in the last seven (7) years?:
Have you or your co-applicant had any foreclosures in the last seven (7) years?:
Do you or your co-applicant have accounts in collection? (no not include medical):
If approved, how many ADULTS (18 years or older) would be living in the Habitat home including you and your co-applicant?
If approved, how many CHILDREN under 18 would be living in the Habitat home? Do not include you and your co-applicant?

**Monthly Amounts Only**

Please tell us your monthly household GROSS INCOME. Enter $0.00 if it does not apply to your household.
$
$
$
$
$
$
Please tell us about your monthly debts. **DO NOT INCLUDE RENT, UTILITIES, CELL PHONE BILLS, INSURANCE OR TV/INTERNET BILLS. Enter $0.00 if it does not apply to your household.
$
$
$
$
$
$
$
Are you willing to make a commitment to the Habitat program, which requires that candidates earn sweat-equity hours and attend a series of workshops?
Please give a brief explanation of the repairs needed.
By signing and submitting this form, I affirm that I have read and understand the program criteria and 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 West Pasco Habitat for Humanity will contact me with the results from this questionnaire, and that I may be invited to complete a Roofs, Ramps & Repairs Application.
Applicant
First Name
Last Name
By signing and submitting this form, I affirm that I have read and understand the program criteria and 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 West Pasco Habitat for Humanity will contact me with the results from this questionnaire, and that I may be invited to complete a Roofs, Ramps & Repairs Application.
Co-applicant
First Name
Last Name
*if not applicable write N/A

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