Counseling Intake:  Personal Information Form 

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Upload all required program application materials listed below. Note: We are unable to accept you into the counseling program if we do not receive all program application materials required in this form. File format needs to be PDF, PNG, JPG or JPEG. We cannot accept alternate file formats, web pages, links, or documents that require a login/password. These documents will be rejected upon review. 









In order for us to verify your identity, please upload a photo or scan of a current State-issued photo identification card for all household members 18 years of age and older

In order for us to verify your identity, please upload a photo or scan of a Social Security card for all household members regardless of age

In order for us to verify your identity, please upload a photo or scan of your Permanent resident card (if applicable)


Proof of employment income for all applicants and household members: 

30 days of most recent consecutive pay stubs

Proof of additional income such as Social Security, child support, alimony, survivor’s benefits, disability, stipend, adoption subsidy, etc. for all household members:

This documentation needs to be in the form of official government or agency-issued verification

 To obtain proof of income for Social Security benefits: socialsecurity.gov or 1.800.772.1213 

To obtain proof of income from child support in Nebraska: childsupport.nebraska.gov or 1.877.631.9973

Tax Documents

Two most recent years of W-2s

The form your employer issues to you annually by January 31st that lists your earnings and tax for the previous year

Two most recent years of tax returns

A series of forms you fill out and file annually by April 15th to show the government how much money you have earned and how much tax you have paid for the previous year

To obtain Tax Return Transcript and/or Wage and Income Transcript (W-2): irs.gov/individuals/get-transcript or 1.866.562.5227 or create an account and access your documents immediately sa.www4.irs.gov/secureaccess/ui/

Bank statement

Please upload the most current monthly bank statement issued by your bank for both checking and savings


Counseling Intake Form

Please upload your completed counseling intake form 

About your Personal Information
Habitat for Humanity of Omaha Privacy Statement and Notice

At Habitat for Humanity of Omaha, we are committed to keeping your information private. We recognize the importance applicants, program families, tenants, and homeowners place on the privacy and confidentiality of their information. While new technologies allow us to more efficiently serve our customers, we are committed to maintaining privacy standards that are synonymous with our established and trusted name.

When collecting, storing, and retrieving applicant, program family, and homeowner data – such as tax returns, pay stubs, credit reports, employment verifications and payment history – internal controls are maintained throughout the process to ensure security and confidentiality. We collect nonpublic personal information about you from the following sources: 

Information we receive from you on applications or other forms; Information about your transactions with us or others; and Information we receive from a consumer reporting agency. We may disclose the following kinds of nonpublic personal information about you: 

Information we receive from you on applications or other forms, such as Name, address, social security number, income, etc.

Information about your transactions with us or others such as you’re your loan balance and payment history.

Information we receive from a consumer reporting agency such as your credit history. Habitat for Humanity of Omaha employees and volunteers are subject to a written policy regarding confidentiality, and access to applicant data is restricted to staff and volunteers on an as-needed basis. Information is used for lawful business purposes and is never shared with third parties without your consent, except as permitted by law.

As permitted by law, we may disclose nonpublic personal information about you to the following types of third parties:

Financial service providers, such as mortgage servicing agents.

Nonprofit organizations, government entities, or other subsidy providers. If you prefer that we do not disclose non-public personal information about you to nonaffiliated third parties, you may opt out of those disclosures, that is, you may direct us not to make those disclosures (other than disclosures permitted by law). If you wish to opt out of disclosures to nonaffiliated third parties, you may call Habitat for Humanity Omaha Inc. at 402-457-5757. (HFHI)

We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmation advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status, national origin, creed or age. 11/2/2022
How we will process your request

How we will process your request


After you have submitted all of the above required program application materials, a counselor will email you to schedule your intake appointment. The appointment will take place at Habitat for Humanity of Omaha, 1229 Millwork Ave. Ste 301 Omaha, NE 68102 and will take 45-60 minutes.

We will answer your request or request additional information from you within 30 days. We may extend this process for up to two months. 

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