Winneshiek County Habitat for Humanity Pre-application Questionnaire
Would you like to own your own home? We want to help families own and keep a good house to live in. Please submit this questionnaire and WCHFH will let you know whether this information fits Habitat's application guidelines.
Name *
Your answer
Address *
Your answer
Telephone *
Your answer
Today's Date *
Your answer
How many people live in your household?
Show the number for the listed age brackets:
0-5 years
Your answer
6-10 years
Your answer
11-15 years
Your answer
16-20 years
Your answer
21-30 years
Your answer
31-40 years
Your answer
41-50 years
Your answer
51+ years
Your answer
What are your monthly rent and average monthly utilities payments?
Rent *
Your answer
Electricity *
Your answer
Heat *
Your answer
Why do you want a better place than the one you are now renting? *
Your answer
What was your family's total gross income from all sources last year, including earnings from all members 18 years of age and older? *
Your answer
Are you willing to work with WCHFH on your own and others' houses? *
Your answer
Where in Winneshiek County do you wish to live? *
Your answer
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