Habitat CDBG-DR Homeownership Interest Form

By completing the form below, you are submitting a Homeownership Interest Form through Habitat for Humanity for homebuying assistance under the CDBG-DR Single Family New Construction Program. Please be sure to fill out all required fields. Once submitted, you will be contacted by a representative of Habitat for Humanity of Bowling Green/Warren County with a Zoom meeting link for the next scheduled homeowner informational session.

Initial Homeownership Interest Form Pre-Application Session runs from March 03, 2025 - March 24, 2025.

Please review these links before completing the Homeowner Interest Form.

Income Limits

General Program Requirements and Qualifications

Name

First Name *

Last Name *

Email

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Phone (Cell)

How did you hear about us?

1. Friend
2. Social Media
3. News
4. ReStore

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I have reviewed the income limits and confirm that my household income falls within the required income limits listed (80% or below of area median income). See link below for review.

1. Yes
2. No

Income Limits

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I have read the requirements and qualifications link for Habitat for Humanity of Bowling Green/Warren County. See link below for review.

1. Yes
2. No

General Program Requirements and Qualifications

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How many people are there in your household?

What is your marital status?

1. Unmarried (single, divorced, widowed)
2. Married
3. Separated
4. Other

What is your residency status?

1. US Citizen
2. Permanent Resident
3. Other

Have you lived or worked in Warren County for at least 12 months?

1. Yes
2. No

Have you owned a home in the past three years?

1. Yes
2. No

Check all that apply. My current housing is:

1. Overcrowded
2. Physically Substandard
3. Too Expensive
4. Unsafe

How would you rate your credit history?

1. Poor (Below 579)
2. Fair (580-669)
3. Good (670-739)
4. Very Good (740-799)
5. Excellent (800-850)

I confirm that I lived in Bowling Green in December 2021.

1. Yes
2. No

List place of address as of December 11, 2021:

Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic Of The Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Côte D'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic Of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the Former Yugoslav Republic Of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Martin Saint Pierre And Miquelon Saint Vincent And The Grenedines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province Of China Tajikistan Tanzania, United Republic of Thailand The Federal Democratic Republic of Nepal Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country

Address Line 1 *

City *

State/Province *

Postal Code *

As a result of the tornadoes that impacted Bowling Green in December of 2021, I experienced the following impacts (check all that apply):

1. Direct Impact & Housing Damage or Loss
2. Loss of Work
3. Loss of Childcare/School Aged Children Issues
4. Loss of Transportation
5. Loss of Electricity or Other Utilities
6. Increased Rent or Housing Cost
7. Lack of Affordable & Affordable Housing
8. Other (Please Explain Below)

If Other is selected above, please explain below:

I attest that the information I provided in this document is, to the best of my knowledge, accurate and truthful. I understand that providing false or misleading information in this document or during this program could result in legal action and/or the repayment of loan funds. Title 18, Section 1001 of the U.S. Code provides that a person is guilty of a felony for knowingly and willingly making materially false or fraudulent statements or representations in any manner within the jurisdiction of any branch of the United States government.

By placing your name here you certify and declare to the best of your knowledge and belief that the information you provided is true, accurate and complete?

First Name *

Last Name *