Complete all information and return this request to:

Avi  Glaser Coordinator of Homes for Good Program.

Community Housing, Inc.

167 Dutton Street Lowell, MA01852

(Phone) (978)-459-0551 x 340

(Fax) (978)-453-9150

aglaser@comteam.org

PLEASE PRINT

Date____/____/____

#1 First Name: ______________________ Initial: ____ Last Name: __________________________

#2 First Name: ______________________ Initial: ____ Last Name: __________________________

Address: ___________________________City: ______________State: _____ Zip Code: ________

Home Phone: (___)_____________ Work Phone:(___)_____________Other: (___)______________

Email: ________________________________________

Are You a First-Time Homebuyer? Yes__   No  __ If  no explain : ___________________________

Are you looking to buy a home?   Now ___ In 3-6 month  ___ In 6-12 month  ___ In over a year   __

Have you completed a First-Time Homebuyers Class? No  __   Yes  __   If Yes:

    Which Agency? ______________________ Location: ____________________ Date: ___/___/____

What is your Annual Household Income? $_____________   Down payment available $_____________

Number of people living in your household Adults: _______   Children under 18 years:_____

Have you been pre-approved by a lending institution? No  ___ Yes __ If  yes please attach.

Please prioritize the towns you will be interested to live in: 1)_______________,  2)______________

3) _________________, 4)_______________,    Minimum number of bedrooms you will need  _____

Would you consider a condominium apartment:   Yes  __ No  __

Agreement and Signature

By signing this application I understand that this is an application to be placed on an affordable home ownership waiting list and is NOT an offer or guarantee of housing. I understand that it is my responsibility to notify Community Housing Inc., (CHI) of any changes in my situation income or address. I agree that Community Housing, Inc. may share my information with other housing related agencies such as Housing Authorities for the purpose of home ownership. I am self-certifying my household income which will be verified if I am considered for an affordable home.