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eligibility questionnaire

Homeowner Eligibility Questionnaire

*Indicates required field.

Have you, the applicant, or co-applicant, if applicable, LIVED in Greater Bangor for at least the last 12 months?
Is either applicant a veteran?
Have you, the applicant, or the co-applicant, if applicable, had steady income (either from a job or other verifiable sources) for at least the last 24 months or more? Other income sources may be Social Security or SSI, SSD, Disability or Retirement, etc.
Have you, the applicant, or the co-applicant, if applicable, ever filed for bankruptcy?
Approved Homeowner Candidates must invest Sweat Equity hours (300 hours for each 1-applicant household; 375 for each 2-applicant household), including completion of pre-purchase educational requirements. This process may take up to a year to complete. Are you willing to make this commitment?
Total Household Monthly Income

List your TOTAL GROSS MONTHLY INCOME for your household, including the income from all those 18 and older who will be living in the home. Include income from these sources: Wages (befor taxes and deductions), Social Security income, alimony, child support you recieve, disability, and any other regular monthly income. Please list each different type of income along with the montly payment.

Do you have any other income sources?
If you checked YES, above, for non-medical collections, is the TOTAL of the non-medical collections more than $2000.00
Do you, the applicant, and/or the co-applicant, if applicable, have any non-medical collections or bad debts? (e.g. car repossessions, defaulted loans or credit cards, defaulted rental housing, etc.)
Acknowledgement of Receipt of Privacy Statement and Notice - I/We acknowledge that I/we have received and read Habitat for Humanity of Greater Bangor Privacy Notice and eCommunications Agreement

By submitting this form, I affirm that the information on this form is true and correct. I understand that providing false information could cause me to be disqualified from the Habitat program. I authorize the verification of the information provided on this form as to my credit, employment, income and background, including criminal background checks. I have received a copy of this initial application. I understand that, based on the information I provided, if my Initial Application meets Habitat Bangor's basic criteria, I will be invited to submit a full Homeownership Program Application. If it does not meet basic criteria, I understand that I will receive an Adverse Action letter. Further, I acknowledge that if I am able to submit a Habitat Homeownership Program Application, and an appraisal is ordered in connection with that application, I will be provided a copy of that appraisal at no cost to me.

Thank you for your submission!

(If you have any difficulty,

please e-mail

Initial Screening Form

Habitat Bangor Privacy Notice

Thank you for your interest in purchasing a home through Habitat for Humanity of Greater Bangor!


This is an initial screening form and not a final application for home ownership.

This form helps us determine if the Habitat for Humanity Homeownership Program is right for your household. It is the first step in the process of applying for a home.

We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. There are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status or nationality.

eCommunications Disclosure and Agreement

Upon receipt of your consent, Habitat for Humanity of Greater Bangor will communicate with you via email. You must provide a working email address to HFHGB. This Disclosure Agreement is applicable only to Habitat for Humanity of Greater Bangor Maine eCommunications service. You will need a personal computer with an internet connection in order to access the internet and email. Any documents sent to you will be in PDF format, so you will also need Adobe Acrobat Reader software to view it. If you wish to print a copy of the document, you will also need a printer connected to your person computer.


You agree that it is your responsibility to ensure that any documents emailed to you cannot be intercepted or viewed by others.


By accepting the terms of this Agreement, you hereby authorize HFHGB to provide communications, disclosures and notifications of document availability to you by electronic mail. Your authorization means that we can provide you with communications, disclosures, statements, notices, applications or other agreements to a working email address provided by you. You are responsible for notifying us of any email address changes. Notification of any email changes will be effective with in ten (10) calendar days after receipt, excluding holidays. You must notify us by email at or by mail addressed to HFHGB 382 Harlow Street, Bangor Maine 04401. If your email is returned as undeliverable, an attempt will be made to contact you by other means. If contact cannot be made, HFHGB will resume sending a paper copy of any communications listed above by U.S. mail to the mailing address on file for your account with HFHGB.


Once you enroll in the eCommunications program, paper documents will no longer be sent to you. Although you have elected to have communications delivered to your electronically, HFHGB can print paper documents for you, subject to any applicable printing fee. To request a paper document, please contact HFHGB via email to, via telephone at 207-942-8977 or by mail at HFHGB, Homeowner Services, 382 Harlow Street Bangor Maine  04401.


You have the right to withdraw your consent to receive email notifications and electronic versions of any documents at any time. To withdraw your consent to receive email notifications and documents, you must notify us via email at: or in writing to: HFHGB Homeownership Services 382 Harlow Street Bangor Maine 04401. The withdrawal of your consent will be effective within ten (10) calendar days of receipt.


All eCommunications and documents sent via email shall be in full compliance with applicable laws and regulations. Your account is also governed by the terms and conditions otherwise applicable to that kind of account as separately disclosed to you, either in applications and enrollment forms, the applicable fee schedules, credits agreements, our Privacy policy or other written disclosures.


You acknowledge that you have read and agree to the terms of this eCommunications Disclosure and Agreement and would like to receive communications and documents via email. You understand that for your account with HFHGB, you will no longer receive paper communications and documents sent by the U.S. mail.


You agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action or to otherwise provide HFHGB with instructions while participating in our eCommunications program or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions, constitutes your signature, acceptance and agreement as if actually signed in writing. Furthermore, you agree that no certification authority or third party verification is necessary to validate your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforcability of your signature or any resluting contract between you and HFHGB. You agree and acknowledge that you will keep your access I.D. and other security codes and identification data confidential, and you will immediately notify HFHGB should you beleive that your access I.D. has beel lost, stolen, or that an unauthorized person has electronicallty accessed your email account.


By agreeing to the terms and conditions of this Agreement, you represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts, and that such persons will be bound by thwe terms of this Agreement.


This Agreement supplements and modifies other Agreements that you may have with HFHGB to the extent that this agreement and other agreements could contain conflicting provisions. This Agreement will govern the delivery of electronic disclosures and documents, but all other contractual obligations of the parties remain subject to the terms of any agreements, including HFHGB mortgages, Promissory Notes, applications, enrollment forms, applicable fee schedules, Privacy policy, or other written disclosures. You will be required to review any account statements you receive and notify HFHGB within established time periods if there are any errors on your account information.


You acknowledge and agree that not all email is secure. Therefore, you agree that HFHGB has no liability to you whatsoever for any loss, claim or damages arising from or to, any email or other electronic communications that HFHGB has submitted to you or that you have submitted to HFHGB. HFHGB also has no duty to investigate the validity or to verify any email or other electronic communications sent or recieved by it. Although HFHGB has no obligation to do so, it reserves the right to require authentication of emails or electronic communications. The decision to require authentication is at the sole disretion of HFHGB. HFHGB will have no obligation, liability or responsability to you or any other person or copmapy if it does not act upon or follow any instruction to it if a communication cannot be authenticated tio its satisfaction.


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