Self-Help Homes Pre-Application

Welcome!

Applicant Status

Are you a US Citizen?

YesNo

If not, are you a Permanent Resident Alien?

YesNo

About the Household

Monthly Debt Payments (i.e. reported to your credit)

$

Total Assets (i.e. investments, retirement accounts, liquid assets)

$

Monthly Rent/Mortgage Payment

$

Authorization

** By signing this application, you are under no obligation to utilize RHDC, DBA Self-Help Homes, for affordable housing or other assistance that may be offered, regardless of recommendations made by its agents or affiliates. **

I certify that the information that I have provided is true to the best of my knowledge. I understand that giving false or misleading information may be grounds for termination of my participation in the program.

I authorize Rural Housing Development Corporation to order a TransUnion credit report if it is needed.

About the Applicants

About the Applicant

First Name

Last Name

Email

Birthdate

Marital Status

Work Phone

Mobile Phone

Home Phone

Preferred Phone

HomeWorkMobile

Place of Employment

Annual Income

$

Do you have a co-applicant?

About the Co-Applicant

First Name

Last Name

Email

Birthdate

Marital Status

Work Phone

Mobile Phone

Preferred Phone

HomeWorkMobile

Is your Co-Applicant currently employed?

YesNo

Place of Employment

Annual Income

$

Are there other adults (persons age 18 or over) other than listed above as the Applicant or Co-Applicant living in the household?

Other Adults in the Household

Enter zero for Annual Income if the person does not earn an income.

	First Name	Last Name	Birthdate	Annual Income

Are there children (under 18) living in the Household?

Children in the Household

	First Name	Last Name	Birthdate

Addresses

Beginning with your current, primary address, please furnish at minimum your (and your co-applicant's) addresses for the last two years.

Current Address

	Street	City	State	Zip/Postal Code

Start Date

Who lived at this address?

Default Address

Have you lived at this address for more than two years?

YesNo

Previous Address

	Street	City	State	Zip/Postal Code

Start Date

End Date

Who lived at this address?

Was this a Mailing Address?

Questionnaire

What is your household gross annual income?

Are you (or the co-applicant) paying child support under a divorce decree?

What amount of Child Support are you paying?

Are you (or the co-applicant) receiving child support under a divorce decree?

What amount of Child Support are you receiving?

Have you (or the co-applicant) ever been convicted of a crime?

If you have been convicted of a crime, please explain:

In the last 24 months, have you (or the co-applicant) had at least two lines of credit for a 12 month period?

Have your monthly payments been made on time?

If your payments have not been on time, please explain:

Have you (or the co-applicant) ever had any of the following? If no, leave unchecked.

Bankruptcy

Judgement

Collection

Bankruptcy Discharge/Payoff Date

Bankruptcy Comments

Judgement Release Date

Judgement Comments

Collection Discharge/Payoff Date

Collection Comments

Have you (or the co-applicant) had any late payments, over 30 days, in the last 12 months?

If so, how many?

Do you (and the co-applicant) have a credit score of 640 or higher?

If you do not have a credit score of at least 640, can you explain why?

Do you currently have ownership/interest in a home or property?

If so, how much equity do you have?

Do you own or have any financial interest in any property, real estate holdings, or business?

If so, what are they?

Do you (or the co-applicant) have one or more checking accounts?

How many checking accounts do you have?

Total amount in checking?

Do you (or the co-applicant) have one or more savings accounts?

How many savings accounts do you have?

Total amount in savings?

Financial Information

In the table below, list your household annual income for the last three (3) years, (the most recent year first).

	Applicant's Income	CoApplicant Income	Total Income
2023
2022
2021

Do you (or the co-applicant) have any additional income other than employment? Example: Housing Assistance, SNAP, Social Security, odd jobs?

If you do have income other than employment, please explain:

In the next section, please provide the applicant's and the co-applicant's current income, and please specify if it's hourly or salary.

Applicant Current Job(s)

	Start Date	Employer	Job Title	Compensation	Rate of Pay	Hours/Week
First Job
Second Job

Co-Applicant Current Job(s)

	Date of Employment	Employer	Job Title	Compensation	Rate of Pay	Hours/Week
First Job
Second Job

Outline current monthly debts such as credit cards, loans, student debt, etc. This does not include cash expenses, food, utilities, insurance, phone, etc.

	Balance	Minimum Payment
Creditor 1	$	$
Creditor 2	$	$
Creditor 3	$	$
Creditor 4	$	$
Creditor 5	$	$
Creditor 6	$	$
Creditor 7	$	$
Creditor 8	$	$

Statement of Commitment

Do you (or the applicant) have adequate transportation to and from the work site?

YesNo

Are you (or the co-applicant) physically able to do light to moderate construction work?

YesNo

Will you be able to arrange adequate child care while you are at the work site (if applicable)?

YesNo

Possible Providers:

Can you (or the co-applicant) realistically work a minimum of thirty-five (35) hours per week on your own, until your group is finished (a possibility of 10-12 months)?

YesNo

Who might help with the volunteer hours?

Do you have specific hours you can work on weekdays? Please select those hours below:

If co-applicant hours differ, please explain:

Can you (or the co-applicant) work on Saturdays from 8:00am to 2:00pm?

YesNo

If no, please explain:

Disclosure Statement

I understand that in applying for Housing Counseling and other Housing Programs, the information which we have furnished is true and is subject to verification, which may include a criminal background check.

Paystub Upload

Please provide two month's worth of paystubs or two paystubs, whichever is greater.

PLEASE NOTE: You cannot submit this application without these attachments.

Click "Choose File" to upload your first file. Click "Add Another Response" to add more files.

Application Comments or Additional Details

If you have any additional details, insights, or explanations for any of the information provided in this pre-application that you'd like to share with us, please use this space.

Additional Comments

	Monday	Tuesday	Wednesday	Thursday	Friday
Start Time
Stop Time