Family Questionnaire

PO Box 267 Kennebunk, Maine 04043
207-985-4850
www.habitatyorkcounty.org

A house is made of walls and beams;
a home is built with love and dreams.”

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Family Questionnaire

First Name: Last Name : Date

Email:

Address:

City: State: Zip Code:

Phone: Cell Phone:
Contact me by: Phone Cell Phone E-mail

Church Affiliation: Town:

Please provide us with information about your family.

List all Family Members who would are living in the Home:

Person Relationship Age

Person Relationship Age

Person Relationship Age

Person Relationship Age

Person Relationship Age

Person Relationship Age

Person Relationship Age

Person Relationship Age

Have you read the requirements for Habitat for Humanity York County Home Ownership ?

Yes No

For more information go to the Home Ownership Page.
The foundation of the Habitat mission is partnering with families, working side by side with them as they help build their homes. A huge part of this partnership is “sweat equity” or volunteer time. Each family must be willing and able to put in 400 hours of volunteer time.


FY 2011 York County, Maine Income Limit Category
	2 Persons	3 Person	4 person	5 person	6 Person	7 Person
	$25,790	$25,790	$25,790	$26,170	$29,990	$37,810
	$29,420	$37,060	$44,700	$52,340	$59,980	$67,260

Annual Household income

How would you and your family fulfil their "sweat equity hours"?

Why would you like to own a Habitat home?

Please give us a brief synopsis of your current living arrangements.

Has anyone in your household ever declared bankruptcy? Yes No
If so, please explain (year, circumstances, where)

Has anyone in your household ever had a criminal conviction? Yes No
If so, please explain:

How did you learn about Habitat for Humanity York County?

A house is made of walls and beams; a home is built with love and dreams.”

Family Questionnaire

FY 2011 York County, Maine Income Limit Category

A house is made of walls and beams;
a home is built with love and dreams.”