Homebuyer Pre-Screening Questionnaire – Habitat Buffalo

Homebuying Program

Complete the questionnaire one of two ways:

Complete the online form below, your submission will be sent directly to our family services team upon completion.
Download the PDF below and send to our family services team. Downloaded questionnaire’s can be completed digitally or printed and sent to:
- familyservices@habitatbuffalo.org
- Habitat Buffalo Attn: Family Services, 1675 South Park Ave, Buffalo, NY 14220.

Homebuyer Pre-Screening Questionnaire

Eligibility Questions

If your current housing situation includes one or more of the following examples you may be eligible for a Habitat for Humanity Home. Select all that apply.(Required)

Substandard: If you have broken plumbing, faulty or unsafe electrical service, poor heating, deteriorating structure, or any other health and safety issue.

Cost Burdened: If your rental payments are 30% or more of your total income.

Overcrowded: If an adult and child, more than two children, or two children of the opposite sex share a bedroom.

None of the above.

How many people would live in the Habitat house?(Required)

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 33950 to 54250.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 38800 to 62000.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 43650 to 69750.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 48450 to 77500.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 52350 to 83700.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 56250 to 89900.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 60100 to 96100.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

What is your total YEARLY household income BEFORE taxes?(Required)

Please enter a number from 64000 to 102300.

The range is based on household size. Annual income must fall within this range to qualify. Income verification will be required with full application.

You do not qualify for the homebuying program.

If you have any questions, please reach out to familyservices@habitatbuffalo.org

Primary Applicant Information

Applicant First Name(Required)

Applicant Last Name(Required)

Applicant Address(Required)

Street Address Address Line 2 City State ZIP Code

Applicant Phone(Required)

Applicant Email(Required)

Applicant Date of Birth(Required)

Applicant Social Security Number(Required)

Applicant Country of Origin(Required)

If U.S., was the applicant born in Buffalo?

Will you be applying with a co-applicant?(Required)

Co-Applicant Information

All fields required if applying with a co-applicant.

Co-Applicant First Name(Required)

Co-Applicant Last Name(Required)

Co-Applicant Address(Required)

Same as primary applicant

Street Address Address Line 2 City State ZIP Code

Co-Applicant Phone(Required)

Co-Applicant Email(Required)

Co-Applicant Date of Birth(Required)

Co-Applicant Social Security Number(Required)

Authorization

By signing this Request for Pre-Screening, I give Habitat for Humanity Buffalo permission to obtain my credit report in order to evaluate me for admission into their homebuyer program.

Primary Applicant Signature(Required)

Co-Applicant Signature(Required)

Click to download the PDF version of the pre-screening questionnaire:

English