HSI Application 2025
Housing Sewanee Inc. (HSI) is a non-profit organization financed through private
donations, grants, and fund-raising activities. We provide affordable housing for individuals and
families in the greater Sewanee area. Volunteer labor does the majority of the work to
construct the homes. Housing Sewanee selects potential homeowners whose financial situation
makes home ownership otherwise difficult or impossible.

If there is a question that does not apply to you, please leave it blank. If you have any questions or need assistance with the application, please email housingsewaneeinc@gmail.com
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Client Information
Full Name *
Current Address
Phone Number
Email Address (if applicable)
Preferred method of communication
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Date of Birth *
MM
/
DD
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YYYY
Marital Status
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List all the people you anticipate will be living with you within the next year. Include their name, age, and gender
Health Information
Do you currently have health insurance?
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What is the current status of your health?
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Have you ever participated in drug rehabilitation treatment? If so, please provide details below (when, where, how long, etc.)
Do you currently have any chronic health issues that might prevent you from climbing stairs or caring for a home? If yes, please provide details:
Do you have any dependents with health issues? If yes, please provide details:
Do you currently own land? If yes, please list the address
I currently live in a...
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I currently...
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How long have you lived at your current residence?
If you currently rent your residence, please list the name, address, and phone number of your landlord. If you have lived there for less than 24 months, please list the contact information for your previous landlord.
Please list any pets (how many, what type) that you have:
Employment Information
List all employers you have worked for over the past 5 years. Include phone number, address, and name of supervisor:
Please list the monthly monetary amounts you receive from each of the following:
Salary
Social Security Benefits
Disability Payments
VA Benefits
Pension
Interest and Dividens
Real Estate Income
Unemployment Benefits
Income From Family Assets
Military Pay
Alimony and Child Support
Welfare Assistance
Payments Received for Care of Foster Children
SNAP Benefits
Women, Infants, and Children Program (WIC)
Other Sources of Income Not Listed
Monthly Expense Information
Rent/Mortgage
Residence Insurance
Utilities (Water, Electric, Gas/Propane)
Phone
Internet/Cable/Streaming 
Vehicle Payment
Vehicle Insurance
Gas/Maintenance Costs
Groceries
Medical/Dental Bills
Prescriptions/Medicine Costs
Childcare/Education
Credit Card Payment
Loan Repayments
Are you currently in, or have you ever filed for, bankruptcy? If yes, please provide details:
List all assets that you own (car, savings account, home, etc.)
Please list 3 references who can attest to your character. Include their name, email address, phone number, and relationship to you.
Reference 1 *
Reference 2
Reference 3
In your words, tell us your story. Please include why you qualify for a HSI home.  *
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