Preliminary Questionnaire Form

Completing this questionnaire is the first step in LHFH’s application process. Reading it carefully will enable you to determine if you are eligible to apply for partnership. You will receive a response from us either confirming your initial eligibility and providing an application for you to complete OR notifying you of ineligibility. Priority in the selection process is based on the level of need, the ability to afford a no-interest mortgage, and the willingness to partner.

Name:
Address:
City: State: Zip:
Home Phone: Work Phone:

NEED: You must have lived or worked in Loudoun County for at least one year and you must have a definite housing need. Housing need is partly based on family size and income. Please show your family size by listing name of each person who would live in the home. Check the total number of people who will live in your home to determine the minimum and maximum income levels.

Family Member Name(s)

X

Family Size

Min Income

*Max Income

1

$20,650

$34,340

2

$23,600

$39,350

3

$26,550

$44,300

4

$29,500

$49,200

5

$31,850

$53,150

6

$34,200

$57,050

7 $36,600 $61,000

8 $38,950 $64,950

Minimum/maximum gross income limits are based on 30% and 50% respectively of 2007 Median Family Income as determined by HUD for the Washington DC Metropolitan Area.

ABILITY TO PAY: Habitat partners must have a stable, but low income that falls within the stated guidelines, and a reasonable credit history which demonstrates financial responsibility. Please include total annual income, before taxes, for all family members (18 years and older) in the household.

Total Total annual gross income of household: $
WILLINGNESS/ABILITY TO PARTNER:
You and your family must agree to contribute the specified sweat equity hours. You and/or family members (16 years old or older) must be able to work Fridays and/or Saturdays on Habitat houses that are under construction. Additional sweat equity hours may be obtained by attending classes, assisting committees, and participating in Habitat events.
Signature:
Date:
 
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Loudoun Habitat for Humanity is pledged to the Virginia's Fair Housing Law, which prohibits discrimination on the basis of race, color, religion, national origin, sex, elderliness, familial status, and handicap. Elderliness means anyone over 55 years of age.

Loudoun Habitat for Humanity (LHFH) focuses on affordable housing for low-income families in Loudoun County.