Bruce Emery - Habitat for Humanity

If you are interested in our repair program, please review the following Selection Criteria sheet and then fill out and return the application. Be sure to include all of the required supporting documents that are listed on the last page.

We are pledged 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, national origin, disability, familial status, age, marital status, sexual orientation, gender identity or lawful source of income.
Selection Criteria
1. Proof of Homeownership

‐ Own home in our project coverage area that is your primary residence.

‐ Provide Proof of Homeowners Insurance Coverage (if you don't have home insurance, let us try to help you obtain it)

‐ Be current on property tax payments (to be verified by Habitat through city website) and be current on mortgage payments.

‐ Veteran applicants may apply if living with relative who owns home.

‐ Have no more than $20,000 in cash assets.
Do you live in one of the following neighborhoods?*
- West Grand
- John Ball Area
- Roosevelt Park
- Black Hills
- Veteran
Due to funding requirements, Habitat Kent’s repair program only partners with homeowners from the above Grand Rapids, Michigan neighborhoods. If you have questions about your neigborhood location or would like refferals to other home repair services please call (616)-588-5258.
Are you a Veteran?*
- Yes
- No
2. Willingness to Partner with Habitat

‐ Complete application package and participate in application process.

‐ Perform required “Sweat Equity” volunteer hours if applicable.

‐ For Projects over $5,000, be willing to accept a forgivable lien against property.

‐ Be present at home the day the work is being completed if possible.

‐ Maintain an attitude of cooperation and treat all stakeholders with respect.

3. Ability to Pay for Repair

- Total household income plus a modest percentage of home value cannot exceed the applicable limit in the chart below (percentage of home value only included when the home is worth more than $153, 360). If the total cost of repairs is less than $1,500 you will need to repay up to 15% of the total cost, or $50, whichever is greater.

‐ If the cost of repairs is $1,500 - $5,000 you will need to repay up to 20% of the total cost of repairs.

If the total cost of repairs is estimated to exceed $5,000 then the following additional requirements apply:

‐ Total Monthly Debt obligations may not exceed 40% of Gross Monthly Income.

‐ Your submitted documentation must demonstrate reliability in paying utilities on time.

‐ Have willingness and ability to repay up to 40% of the total project cost with a reasonable payment plan.
AMI limits updated 6/8/18

Note: Habitat for Humanity of Kent County approves repair projects based on critical repair assessments, health & safety needs, budgetary constraints, and location. We reserve the right to decline any potential project that does not fit our stated goals.

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We are pledged 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, national origin, disability, familial status, age, marital status, sexual orientation, gender identity or lawful source of income.

Instructions: Completely fill out the application (please complete all blanks). If your application is incomplete, you run the risk of not being accepted into the program. Along with this application, please be sure to turn in copies of all documents on the List of Supporting Documents which is on the last page. Please turn in the application by the due date written on page one. Your application will be kept confidential.
Applicant Information
Applicant Name*
First Last
Gender
- Male
- Female
Social Security # (or ITIN #):
Date of Birth
Phone*
Email
Co-Applicant Information
Co-Applicant Name
First Last
Gender
- Male
- Female
Social Security # (or ITIN #):
Date of Birth

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Willingness to Partner
As part of the Willingness to Partner criteria, you will be required to pay a certain amount of the expenses incurred to repair your home. You may also be required to to sign a forgivable lien. Please read the following points carefully:
1. If the cost of repairs is less than $1,500 you will need to repay up to 15% of the total cost, or $50, whichever is greater. If the total cost is $1,500 - $5,000 you will need to repay up to 20% of the total cost of repairs.

2. In most cases, you will have the opportunity to complete Sweat Equity volunteer hours for credit against your repayment.

If total project costs are over $5,000 then the following two points apply:

3. The co-payment will be 40% of total project costs. Additional Sweat Equity can be completed to lower the co-payment to 30% of the total project cost. You will need to agree to a payment plan before repairs begin. You will have an opportunity to help decide what the payment plan should be.

4. You will be required to sign a forgivable lien also known as a forgivable second mortgage in the amount of the total project expenses only if the total cost is over $5,000. This lien will be reduced over time and will be forgiven after 5 years as long as you make your agreed upon payments. The forgivable lien helps ensure that you are not taking advantage of the program to repair your home so that you can immediately sell it for a profit. Living in the home for at least 5 years after the repairs are complete effectively means the forgivable lien will not effect you at all.

*By signing below, you are indicating your Willingness to Partner with Habitat *
Applicant Signature*

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Asset Information
*Please list all household cash assets (checking & savings accounts, CDs, other bank accounts, cash, etc.) If you have more than $20,000 in cash assets, then you do not qualify for this program.
Bank/Credit Union Name
Balance/Amount*

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Employment Information
Are you currently employed?
- Yes
- No
If not employed, please explain:
Current Employer Name
Address
Street Address City State ZIP Code
Phone
Fax
Type of Business
Position/Title
Average Hours/Week
Wage
Start Date
Please include details on any other jobs in the past 12 months:

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Feedback
*How did you hear about Habitat for Humanity (please check all that apply)
- Friend
- Employer
- Relatives
- Caseworker
- Place of Worship
- Internet
- Television
- Radio
- Newspaper
Other
Habitat program participant (please name):

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Agreement, Authorization, and Release: Applicant and all household members age 18 and older: I am authorizing Habitat for Humanity of Kent County, Inc. (HFHKC) to evaluate my actual need for repairs to my home, my ability to repay the amount agreed upon for repairs, and my willingness to partner with Habitat. I understand that the evaluation will include personal visits (including an inspection of my home). I understand that providing false information is grounds for denial. I also understand that completion of this application in no way guarantees that I will receive assistance through the HFHKC Neighborhood Improvement Program. I authorize HFHKC to pull my credit report and screen my name against sex offender registries. I also understand that data collected from this application may be used along with other applicant data for statistical analysis. Confidentiality of personal information will be maintained according to HFHKC's Confidentiality Policy.
*Please read the following statements carefully and sign - *All household members who are age 17 and over should sign.
Applicant and all household members age 18 and older: I am authorizing Habitat for Humanity of Kent County, Inc. (HFHKC) to evaluate my actual need for repairs to my home, my ability to repay the amount agreed upon for repairs, and my willingness to partner with Habitat. I understand that the evaluation will include personal visits (including an inspection of my home). I understand that providing false information is grounds for denial. I also understand that completion of this application in no way guarantees that I will receive assistance through the HFHKC Neighborhood Improvement Program.

I authorize HFHKC to pull my credit report and screen my name against sex offender registries. I also understand that data collected from this application may be used along with other applicant data for statistical analysis. Confidentiality of personal information will be maintained according to HFHKC's Confidentiality Policy.

17 year olds: By signing below, I acknowledge that HFHKC will screen my name against sex offender registries. Confidentiality of personal information will be maintained according to HFHKC's Confidentiality Policy.
Applicant Signature*
Co-Applicant or Household Member 1 Signature
Household Member 2 Signature
Household Member 3 Signature
Household Member 4 Signature
Household Member 5 Signature
Date*
MM
DD
YYYY

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Confidentiality Policy
*All information in your application package will be kept confidential

Habitat for Humanity of Kent County is committed to maintaining the confidentiality of non-public information regarding applicants, homebuyers, and homeowners in compliance with the law. Accordingly, board members, employees, and volunteers who are permitted to have access to non-public information regarding applicants, homebuyers, and homeowners shall not disclose any of it to third parties without their consent, except as permitted by law. Access to non-public information (such as personal information, tax returns, pay stubs, income documentation, credit reports, housing payment status and history, etc.) is restricted to board members, employees, and a limited number of volunteers on a need-to-know basis.

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