APPLICATION PROCESS Meadow Hill Development - Nanaimo 2360 Extension Rd. 1 4 Bedroom House

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1 APPLICATION PROCESS Meadow Hill Development - Nanaimo 2360 Extension Rd. 1 4 Bedroom House Note: Only suitably sized families will be considered (For example a single parent with 2 children would not be eligible) Application form and additional information found on Habitat for Humanity Mid-Vancouver Island website: Please submit completed application including letter to: Habitat for Humanity Mid-Vancouver Island # Mostar Road, Nanaimo, BC V9T 6C info@habitatmvi.org Application deadline: Monday, June 18th, 2018 at 4:00 pm All applications will be reviewed by the Family Selection committee. Eligible candidates will be asked to attend an information meeting in early July. 1. Only applicants that do not own their own residence or other property are eligible to be considered as a future Habitat homeowner. 2. An applicant must have a verifiable and stable family income for the past 3 years. 3. Applicants who have filed for bankruptcy shall be excluded from the selection process until a discharge of bankruptcy has been received and the applicant has established a subsequent three-year history of income and debt stability. We build strength, stability, self-reliance and independence through affordable homeownership.

2 Application Received: APPLICATION FOR A HABITAT HOME APPLICATION DEADLINE: MONDAY, June 18th, 2018 BY 4:00 PM Please provide a detailed letter giving the Family Selection Committee additional information about your current situation that is not included in the application form. Please contact the Habitat office at or by at info@habitatmvi.org with any questions. Applicant's Name 1. APPLICANT AND CO-APPLICANT INFORMATION PLEASE PRINT CLEARLY APPLICANT CO-APPLICANT Co-Applicant's Name Age Birthdate (Mth/Day/Yr) Present Address in Full Number of years there Home phone Cell phone Work phone SIN Number Canadian Citizen Landed Immigrant Other (attach explanation & documentation) Married Common-law Unmarried (single, divorced separated, widowed) If living at present address for less than 3 years, complete the following: Previous Address in Full Own Rent Number of years there Monthly rent $ Age Birthdate (Mth/Day/Yr) Relationship to Applicant Present Address in Full Number of years there Home phone Cell phone Work phone SIN Number Canadian Citizen Landed Immigrant Other (attach explanation & documentation) Married Common-law Unmarried (single, divorced separated, widowed) If living at present address for less than 3 years, complete the following: Previous Address in Full Own Rent Number of years there Monthly rent $ Application for Habitat Home Deadline: Monday, June 18th, 2018 at 4:00 pm Page 1 of 5

3 Dependents living in applicant and co-applicant's home (for additional members please attach a list) Birthdate (Mth/Day/Yr) Age Female Birthdate (Mth/Day/Yr) Age Female Birthdate (Mth/Day/Yr) Age Female Birthdate (Mth/Day/Yr) Age Female 2. WILLINGNESS TO PARTNER To be considered for a Habitat home, you and your family must be willing to complete 500 hours of volunteer service to Habitat for Humanity Mid- Vancouver Island. Your participation in the process of building your home and the homes of others is called "sweat equity" and may include clearing the lot, painting, helping with construction, working in the Habitat ReStore, participation in promotional activities involving the media or other approved activities. This may include publication of photos of you and your family before, during and after the build for promotional purposes. At no time will anyone performing these volunteer hours be provided with compensation by Habitat for Humanity. I AM WILLING TO COMPLETE THE REQUIRED SWEAT EQUITY HOURS AND AGREE TO THE ABOVE-NOTED ACTIVITIES. Applicant Signature Co-Applicant Signature Do you see any challenges with completing the 500 hours of sweat equity or with the other activities requested of you? Please explain the nature of these challenges. 3. CURRENT HOUSING CONDITIONS Number of bedrooms in your current home (please circle) Other rooms in the place where you live now: Kitchen Bathroom Living Room Dining Room Other (please describe) Describe the condition of your current home and the neighborhood you live in. Please explain why your family should be considered for a Habitat home. How is your current housing situation not meeting your needs? (continued to next page). Application for Habitat Home Deadline: Monday, June 18th, 2018 at 4:00 pm Page 2 of 5

4 Do you anticipate a change in your family size in the near future? Do all family members reside in the current (same) accommodation? Are there special needs that you would require in your Habitat house ( e.g. disabled accessibility)? 4. EMPLOYMENT INFORMATION Please supply work history for the past three years Applicant Current Job Co-Applicant Current Job Position Held? Work Phone Start Work Phone Start Applicant Previous Job 2 Co-Applicant Previous Job 2 Work Phone Start End Work Phone Start End Applicant Previous Job 3 Co-Applicant Previous Job 3 Work Phone Start End Work Phone Start End Application for Habitat Home Deadline: Monday, June 18th, 2018 at 4:00 pm Page 3 of 5

5 Applicant Previous Job 4 Co-Applicant Previous Job 4 Work Phone Start End Work Phone Start End Name of Household Member Any Other Household Members With Income Name of Household Member Name and address of employer or source of income (pension, retirement etc.) Name and address of employer or source of income (pension, retirement etc.) Work Phone Start Work Phone Start continued next page Application for Habitat Home Deadline: Monday, June 18th, 2018 at 4:00 pm Page 4 of 5

6 NOTE: ALL BLANKS BELOW MUST BE COMPLETED. IF THE BLANK DOES NOT APPLY, PLEASE PRINT N/A (NOT APPLICABLE). 5. MONTHLY INCOME AND TOTALS Monthly Income Before Tax Applicant Co-Applicant Others* Monthly Income Before Tax (Gross) Current job Monthly Income Before Tax (Gross) 2 nd Job if applicable Monthly Social Assistance Monthly Child Tax Benefits Monthly Disability Monthly Spousal Support Monthly Child Support Monthly Pension Income Any Other Income (attach written explanation and proof of income) Total Monthly Income Before Tax *For permanent household members who are not co-applicants, we need information regarding their length of residence and contributions to the income of the household. Please attach a separate sheet and explain. 6. MONTHLY EXPENSES AND TOTALS Monthly Expenses Applicant Co-Applicant Others* Monthly Rent Monthly Phone(s) Payment Monthly Hydro Payment Monthly Natural Gas Payment Monthly Cable Payment Monthly Car Payments (loan/lease) Monthly Insurance (Medical) Monthly Insurance (Car, Home Monthly Credit Card Payments Monthly Student Loan Payments Monthly Spousal/Child Support Monthly Line of Credit Payment Monthy Personal Loan Payment Other T l M hl E 7. LONG TERM DEBTS YOU OWE Long Term Debts Applicant Co-Applicant Others* Total Balance on Visa/Mastercard Other Credit Cards Total Balance on Car Loan Total Balance on Student Loans Total Balance on Line of Credit Total Balance of Personal Loans Total Balance on Other Debts Please explain Total Long Term Debts Owing Please ensure you have attached your letter providing further details regarding your current living situation. The undersigned declare(s) that the statements made in this application are true and correct. Signature of Applicant Signature of Co-Applicant Application for Habitat Home Deadline: Monday, June 18 th, 2018 at 4:00 pm Page 5 of 5