To submit your questionnaire, individuals are required to pay a $30 non-refundable processing fee and joint applicants (2 people) will require a $55 non-refundable processing fee.

By submitting this questionnaire, you give Trinity Habitat permission to pull your credit.

Not ready to complete your questionnaire? That’s okay! You can complete it at a later date by using this link: www.trinityhabitat.org/cq

Counseling Questionnaire

A modern house on a green hillside with snow-capped mountains in the background under a cloudy sky.

Primary Borrower Information

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Social Security Number

Current Residence

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When did you move into your current residence?

YYYY

Monthly Rent Payment

Average Monthly Utility Payment

Include the average total you pay each month for utilities such as electricity, water, gas, trash, and internet. If utilities are included in your rent, you can enter $0.

How many bedrooms does your current residence have?

Previous Residence - Move In Date

YYYY

Previous Residence - Move Out Date

YYYY

Borrower Employment Information

Name of Current Employer

Position / Job Title

Job Start Date

YYYY

Name of Previous Employer

Job Start Date

YYYY

Job End Date

YYYY

Borrower Income Information

How are you paid?

Hourly

Salary

Do you recieve child support?

Do you have any additional sources of monthly income?

Examples of other monthly income include: alimony or spousal support, SS, SSDI, VA benefits, and self-employment.

Dependents

The following questions are about any family members under the age of 18 years old.

How many dependents will live in the home?

A dependent is someone under the age of 18 years old.

For each dependent, provide the following:

First and last name Relationship (e.g., son, daughter, niece, nephew) Date of birth (MM/DD/YYY)

Borrower Signature

Have you declared bankruptcy in the past 3 years?

Are you a US citizen or legal permanent resident alien?

Are you willing to do 200 hours of sweat equity to build your home?

I authorize Trinity Habitat for Humanity to obtain a consumer report and other information necessary for the purpose of evaluating my qualification for the Habitat program.

by checking this box, I agree to the above statement.

Borrower Signature

By typing your full name below, you confirm that you have truthfully answered all questions.

Co-Borrower Information

Do you have a co-borrower?

If you are legally married, you must BOTH fill out and sign this form. Your spouse is your co-borrower.

Counseling Questionnaire

Counseling Questionnaire

Trinity Habitat For Humanity

Office

Contact

ReStore North FW

ReStore Arlington

ReStore South FW

ReStore Johnson County