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 *
Address *
Telephone *
Today's Date *
How many people live in your household?
Show the number for the listed age brackets:
0-5 years
6-10 years
11-15 years
16-20 years
21-30 years
31-40 years
41-50 years
51+ years
What are your monthly rent and average monthly utilities payments?
Rent *
Electricity *
Heat *
Why do you want a better place than the one you are now renting? *
What was your family's total gross income from all sources last year, including earnings from all members 18 years of age and older? *
Are you willing to work with WCHFH on your own and others' houses? *
Where in Winneshiek County do you wish to live? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.