Housing Interest Form You will be considered for a Habitat home if your present housing is not adequate, and if you are unable to obtain adequate housing through other conventional means. Lack of adequate housing may include problems with the present structure; water, electrical or sewage service systems; heating system, or failure to meet city property maintenance standards. Also taken into consideration are the number, the ages and the gender of children compared to the number of bedrooms in your present home. The percentage of your monthly income that you currently spend on housing is considered to determine need. You will be required to openly and fully discuss your financial situation with Habitat personnel. You and your family will be considered if your annual total income is between 30-50% of the median income for Calvert and St. Mary's Counties. To be considered, please complete the following form. First Name * Last Name * Street Address * City * State * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Email Phone * Cell Phone Household InformationHousehold SizeNumber of Adults (Over 18)Children's AgesMarital Status - select Marital Status - Married Divorced Separated Widowed Single (Never Married) Employer/Work InformationPrimary EmployerPrimary Employer Hourly RatePrimary Employer Hours Per WeekSecondary EmployerSecondary Employer Hourly RateSecondary Employer Hours Per Week Financial Information Please fill out fields with additional income dollar amountsAlimonyChild Support (Actually Received)DisabilityFamily AssistanceFood StampsSSIOther IncomeOther Income DescriptionType of Bankruptcy - select Type of Bankruptcy - None Chapter 7 (Debt Cancellation) Chapter 13 (Repayment Plan) Date of BankruptcyHas the Bankruptcy Been Discharged?Yes No Submit Cancel