Self-Help Homes Pre-Application

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Welcome!  

Getting Started


Applicant Status
About the Household

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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.

About the Applicants

About the Applicant











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About the Co-Applicant











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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

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



Previous Address
Street City State Zip/Postal Code




Questionnaire












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




















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
2018
2017
2016



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.
 Name   Balance Minimum Payment
Creditor 1
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Creditor 2
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Creditor 3
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Creditor 4
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Creditor 5
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Creditor 6
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Creditor 7
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Creditor 8
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Statement of Commitment







Do you have specific hours you can work on weekdays?  Please select those hours below:
Monday  Tuesday  Wednesday  Thursday  Friday 
Start Time
Stop Time



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.  

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.