PRELIMINARY HOMEOWNER APPLICATION Applicant Name________________________________________________________________________ Address__________________________________________
City__________________ Zip___________ Home Phone_____________________
Social Security #_______________________________________ Date of Birth___________________
Ethnicity___________________
Number of Dependents________ Marital Status □ Married □ Single □ Separated □ Widowed Name & Address of Employer ____________________________________________________________ Type of Business_____________________________________________ Phone_____________________ No. Years on Job______ Line of Work_____________
Position/Title____________________________ Co-Applicant Name_____________________________________________________________________ Address__________________________________________
City__________________ Zip___________ Home Phone_____________________
Social Security #_______________________________________ Date of Birth___________________
Ethnicity___________________
Number of Dependents________ Marital Status □
Married □
Single □ Separated □ Widowed Name & Address of Employer ____________________________________________________________ Type of Business_____________________________________________ Phone_____________________ No. Years on Job______ Line of Work_____________
Position/Title____________________________ How did you hear about Rebuilding Together Have you previously submitted an application to Rebuilding Together San Diego (formerly
known as Christmas in April)?
□
Yes □ No If yes, when?
_____________ What work was done? _______________________________ Have you applied to any other organization for either
a loan or a grant to repair or improve your home? □
Yes □ No If yes, please
provide information _________________________________________ Annual Income
Total Annual
Gross Income___________________ Mortgages First Mortgage Holder Name___________________________________________ Payment__________ Second Mortgage Holder Name_________________________________________ Payment__________ Name(s) on Title__________________________________________ Property Taxes________________ Property □ Home □ Mobile Home Condo House Sq. Footage___________ # of Bedrooms______ # of
Bathrooms______ # Years
in home______ Do you have homeowners insurance? □ Yes □ No Carrier_____________________________________ Known Repairs,
Work Needed, and Hazards Prioritize the work needed on the property: 1._________________________________________ 3. _________________________________________ 2. _________________________________________4. _________________________________________ Additional Needs_______________________________________________________________________ ______________________________________________________________________________________ Do you or anyone in your home have physical disabilities of which we should
be aware in assessing the repairs in your home? _______________________________________________________________ ________________________________________________________________________ If your home were selected,
would you see yourself and/or your family members helping the volunteers
accomplish the repairs to
your home? □
Yes □ No If no, why? ________________________ Do you plan on selling this
property in the next year?
□ Yes □ No List any agencies, programs or church groups in which you participate _________________________ ______________________________________________________________________________________ I/We certify that the above information is true and correct
to the best of my/our knowledge. I/We also authorize you to check any
references necessary to complete the processing of this application
for the purpose of receiving housing rehabilitation through Rebuilding
Together San Diego. I/We also understand that any information received
will be kept confidential
and will be used strictly for the purpose of determining my/our eligibility
to receive housing rehabilitation. Applicant’s Signature __________________________________________
Date____________________ Co-Applicant’s Signature ________________________________________Date____________________ Referred by____________________________________________
Relation________________________ Phone Number__________________ Address_______________________________________________ MAIL TO: Rebuilding Together San Diego, 2013 Frankin Avenue, San Diego, CA 92113 FAX TO: (619) 231-7870 EMAIL TO: rtsd@RebuildingTogetherSD.org |
