Application for a Habitat Home

Date: Application for a Habitat Home If you have uestions about how to fill out this form, please call the Habitat office at 250-334-3777 ext.226 and leave a message for Family Services. Someone will return your call and assist you. 1. APPLICANT INFORMATION Applicant Co-Applicant Applicant's Age & Birth date Applicant's Age & Birth date Present Address In Full Own Rent ( to Applicant) Present Address In Full Own Rent Number of Years There SIN# Number of Years There SIN# Email Address: Email Address: Cell # Home # Work # Cell # Home # Work # Canadian Citizen Other (Attach Explanation & Documentation) Landed Immigrant Canadian Citizen Other (Attach Explanation & Documentation) Landed Immigrant Married Common-law Unmarried (Single,divorced,separated,widowed) Married Common-law Unmarried (Single,divorced,separated,widowed) Dependants (people who live with you other than the co-applicant) Dependants (people who live with you other than the applicant) Age M or F? Age M or F? Status Cdn. Citizen? Landed Immigrant? Other? Status Cdn. Citizen? Landed Immigrant? Other? Age M or F? Age M or F? Status Cdn. Citizen? Landed Immigrant? Other? Status Cdn. Citizen? Landed Immigrant? Other? Age M or F? Age M or F? Status Cdn. Citizen? Landed Immigrant? Other? Status Cdn. Citizen? Landed Immigrant? Other? For additional household members please include a list with names, relationship to the applicant(s), and status to work and reside. If living at Present Address for Less Than Three Years, Complete the Following Previous Address In Full Previous Address In Full Own Rent Own Rent Number of Years There Monthly Rent Number of Years There Monthly Rent Date Application Received Updated Sept/2016

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 Vancouver island North.Your participation in the process of building your home and the homes of others is called "sweat euity". and may include clearing the lot, painting, helping with construction, working in the Habitat office, or other approved activities. 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. Applicant Sign Here Co-applicant Sign Here In which community are you applying to: Campbell River Comox Valley 3. HOUSING CONDITIONS Number of Bedrooms in your current home (please circle) 1 2 3 4 5 Other rooms in the place where you live now: Kitchen Bathroom Living Room Dining Room Other (please describe, address and phone number of current landlord: In the space below, describe the condition of your current home and the neighborhood you live in. Why would you like to partner with Habitat? How is your current housing situation not meeting your needs? Do you anticipate a change in your family size in the near future? Do all family members reside in the current (same) accomodation? Are there special needs that you would consider in choosing or building a house (disabled accessibility, room for parents/grandparents, etc.)? How did you hear about Habitat for Humanity?

4. EMPLOYMENT INFORMATION Please supply work history for the past year and a letter from each person's employer confirming this information together with a copy of that person's most recent Notice of Assessment from Revenue Canada. If Income has changed, please provide a pay stub to reflect this change. Applicant - Current Job Co-Applicant - Current Job Work Phone Start Date Finish Date Work Phone Start Date Finish Date Applicant - Previous Job 1 Co-Applicant - Previous Job 1 Work Phone Start Date Finish Date Work Phone Start Date Finish Date Applicant - Previous Job 2 Co-Applicant - Previous Job 2 Work Phone Start Date Finish Date Work Phone Start Date Finish Date If you have a second job, please complete the following: Applicant - Second Job and address of secondary employer, if applicable. Co-Applicant - Second Job and address of secondary employer, if applicable. Work Phone Start Date Work Phone Start Date Any Other Household Members With Income 18 & older of Household Member - of Household Member - + address of employer or source of income (pension or retirement etc) + address of employer or source of income (pension or retirement etc) a) Please include Most Recent Notice of Assessment. a) Please include Most Recent Notice of Assessment. b) If your pay has changed, please provide a current pay stub. b) If your pay has changed, please provide a current pay stub. Work Telephone Number Start Date Work Telephone Number Start Date

NOTE: All blanks on this page 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* Documents Enclosed? Monthly Income After Tax - Current Job Monthly Income After Tax - Current Job Monthly Child Tax Benefits Monthly Disability Monthly Spousal Support Monthly Child Support GST Rebate (Total/12) Provincial Childcare Supplements Rental Subsidy Assistance Monthly Pension Income Any other Income (attach written explanation of this income) Total PLEASE NOTE * 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. Please provide current proof of income for applicant and co-applicant. Proof of income must include (1.) a T-4 slip for the most recent year, (2) Revenue Canada Notice of Assessment, (3) a letter from your employer confirming (a) the length of your employment and (b) the annual rate of pay or the number of hours worked per week with the hourly rate of pay (4.) Employment Insurance (EI) benefits statement and other documents, if applicable. For any history of bankruptcy, copies of discharge documents must be submitted. Monthly Rent Monthly Car Payments Child Care Monthly Credit Card Payments Monthly Student Loan Payments 6. MONTHLY EXPENSES AND TOTALS Monthly Expenses Applicant Co-Applicant Others Monthly Spousal/Child Support Payment Other Total Balance on Master Card Total Balance on Visa Other Credit Cards (Zellers, Canadian Tire, etc.) Total Balance on Car Loan Total Balance on Student Loans Total Balance on Line of Credit Total Balance on Personal Loans Total Balance on Other Debts - Please Explain Total Total Amounts Owing 7. LONG TERM DEBTS YOU OWE

8. ASSETS List All Financial Accounts such as Cheuing, Savings, RRSP's and others and Address of Bank and Address of Bank Total of above accounts Do you own any real estate? Please provide location & market value Total of above accounts Do you own any real estate? Please provide location & market value Do you own an automobile? Please provide year, make and model Do you own an automobile? Please provide year, make and model 9. PERSONAL REFERENCES Please list at least 3 references from: Previous or current landlord, previous or current employer, neighbor, pastor, or family friend. and address of First Reference and address of Second Reference to Applicant to Applicant Work Number Second Number Work Number Second Number and address of Third Reference and address of Fourth Reference to Applicant to Applicant Work Number Second Number Work Number Seond Number The undersigned declare(s) that the statements made in this application are true and correct. I/we, the applicant(s), consent to any inuiries by Habitat for Humanity Vancouver Island North deemed necessary to reach a decision on this application, including contacting references, and I/we consent to the disclosure at any time of any credit information about me/us by any credit reporting agency or by anyone with whom I/we have financial relations. I/we, the applicant(s), further certify that I/we have answered all the uestions truthfully and to the best of my/our knowledge. Date Signature of Applicant Date Signature of Co-Applicant **PLEASE ENSURE THAT YOU PROVIDE US WITH ALL REQUIRED INFORMATION WHEN APPLYING. SEE CHECKLIST.

THE FOLLOWING DOCUMENTS MUST BE INCLUDED FOR BOTH APPLICANT AND CO-APPLICANT Please provide photocopies and not originals Please ensure all areas of the application are completed and all documents are included in your application before submitting. Missing information will impair your review process. If you have any uestions please call 250-334-3777 ext.226 Applicant Co-applicant 1. Proof of Eligibility to Work and Reside in Canada Canadian Citizenship or birth certificate if born in Canada OR permanent resident status 2. Employment Information - a letter from your employer stating: a) Current Earnings b) How long you worked there c) Whether you are full time or part time, permanent or on seasonal contract 3. Rental information Either a letter from your landlord stating your current rent or a cancelled cheue or bank statement showing the current rent. 4. Financial Information If an item does not apply please print NA (Not Applicable) a) Your most recent Notice of Assessment from Revenue Canada b) Please provide a current pay stub. c) Statements of amounts owing on every credit card and loan d) Assessment of Child Tax Benefit from Revenue Canada e) Statement of provincial childcare supplements f) Statement of any disability income h) Discharge papers if you declared bankruptcy within the last 5 years i) Information about income from any other member of your household 18 and older j) Credit Check - Euifax.ca K) GST Assessment When you have completed your application, please seal all documents in a large envelope clearly marked with FAMILY SELECTION COMMITTEE along the front. Either mail of drop application off at either the Habitat Office or ReStore.

Your Family Income Step 1: Calculate the income for each family member from their paycheue. 1. Record the net income for each pay cheue on the lines below 2. Write the family member s name in column A 3. Write the regular net paycheue amount next to either: weekly, bi-weekly or twice a month in Column B 4. Multiply the paycheue amount by the figures in Column C Calculate Monthly Income from your pay cheue (A) (B) (c) (d) Pay Cheue 1 Net Income on the Pay Stub Monthly Income for budget purposes Weekly X 52 / 12 ($ - ) Bi-weekly X 26 / 12 ($ - ) Twice Monthly X 2 ($ - ) Pay Cheue 2 Net Income on the Pay Stub Monthly Income for budget purposes Weekly X 52 / 12 ($ - ) Bi-weekly X 26 / 12 ($ - ) Twice Monthly X 2 ($ - ) Pay Cheue 3 Net Income on the Pay Stub Monthly Income for budget purposes Weekly X 52 / 12 ($ - ) Bi-weekly X 26 / 12 ($ - ) Twice Monthly X 2 ($ - ) Pay Cheue 4 Net Income on the Pay Stub Monthly Income for budget purposes Weekly X 52 / 12 ($ - ) Bi-weekly X 26 / 12 ($ - ) Twice Monthly X 2 ($ - ) Step 2: Record all your Income 1. Transfer the monthly Income to the Box to the right. 2. Record the other monthly income your family receives 3. Add the amounts in the column to calculate your Family Monthly Net Income. Write the monthly income amount in Column D Your Total Monthly Income (Use only monthly amounts) Pay Cheue 1 ($ - ) Pay Cheue 2 ($ - ) Pay Cheue 3 ($ - ) Pay Cheue 4 ($ - ) Child Tax Benefit Support Payments Other Monthly Income

Other Monthly Income Other Monthly Income Total Monthly Net Income ($ - ) 1 Step 3: Transfer the amount to the Balancing Your Budget Box on Page 2 beside Total Monthly Net Income - 1.

Your Family Expenses Expense Annual/Other Monthly Average % Over Short Term Savings (A) Long Term Savings (B) Rent & Heat 35% Home/Tenant Insurance Cable TV/Internet/phone 5% Groceries/personal care/baby 20% Clothing 5% Car Gas/Maintenance/Insurance 20% Medicine/Dental 3% Child Care/Babysitting Entertainment/alcohol/tobacco 10% Pocket Money Child Allowance Tithing 10% Loan Payment Support Payment Credit Card Payments Subtotal 1 ($ - ) ($ - ) Instructions: 1) Transfer all your expenses from your list of expenses. a. If you spend weekly or monthly on the item enter the Monthly amount in Column: Monthly b. If you spend once per year (annual) enter the amount in Column: Annual/Other. c. If you spend two to six times per year estimate the annual amount and enter into the Annual Column (# of times per year x the amount = Annual amount) 2) Check: Are these all the expenses for your family? 3) Calculate your monthly savings amount for your Short Term Savings (A) and Long Term Savings(B) 4) Add each column on the expense worksheet. 5) Transfer the column totals to the Expenses Table and add the amounts. 6) Transfer Total 2 to the Balancing your Budget Box. 7) Average is a Canadian national average for this expense. Calculate you are spending the proper amount. Add Subtotals from Expense Table Balancing Your Budget A1 ($ - ) (Total Annual) Total Monthly Income #REF! TMA ($ - ) (Total Annual/12) Total Monthly Expenses ($ - ) M1 ($ - ) (Total Monthly) Difference (+/-) #REF! Total Monthly Expenses ($ - ) Do you have money left over at the end of the month? If so, great! Your income and expenses are balanced. What if your expenses are more than your income? Your budget is out of balance. You need to cut your expenses or earn more money