Program Application
Hafa Adai!

This is a Confidential Pre-qualification Form with Micronesia Community Development Co.

**All information is held in the strictest confidence and used only for loan pre-qualification purposes. Please ensure responses are as accurate as possible to help us help you the best way we can.

Thank you!
Applicant Interest
What you like to apply for? *
What island would you like to apply for? *
Applicant Information
Full Name *
Present Address
Previous Address
Date of Birth
MM
/
DD
/
YYYY
Email Address
Home Phone
Work Phone
Mobile Phone
Are you a Veteran?
Clear selection
Are you currently in the Military?
Clear selection
Are you a citizen or permanent resident of U.S.?
Clear selection
Have you ever obtained a loan from FmHA ?
Clear selection
If yes, when?
MM
/
DD
/
YYYY
If yes, where?
Employer Information
Employer Name
Employer Address
Date of Employment
FROM
MM
/
DD
/
YYYY
TO
MM
/
DD
/
YYYY
Type of Work
Income
You must include all income from all sources. (i.e., full time, part time or seasonal employment, overtime pay, commissions, tips, child support, bonus, SSI, Social Security, unemployment, retirement, V.A., D.S.H.S., pensions, other)
Employment Income before deductions:
Employment Income
Clear selection
Other Applicant Income
Co-Applicant Information
Full Name *
Present Address
Previous Address
Date of Birth
MM
/
DD
/
YYYY
Email Address
Home Phone
Work Phone
Mobile Phone
Are you a Veteran?
Clear selection
Are you currently in the Military?
Clear selection
Are you a citizen or permanent resident of U.S.?
Clear selection
Have you ever obtained a loan from FmHA ?
Clear selection
If yes, when?
MM
/
DD
/
YYYY
If yes, where?
Employer Information
Employer Name
Employer Address
Date of Employment
FROM
MM
/
DD
/
YYYY
TO
MM
/
DD
/
YYYY
Type of Work
Income
You must include all income from all sources. (i.e., full time, part time or seasonal employment, overtime pay, commissions, tips, child support, bonus, SSI, Social Security, unemployment, retirement, V.A., D.S.H.S., pensions, other)
Employment Income before deductions:
Employment Income
Clear selection
Other Applicant Income
Other Household Income
 You must include all income from all sources for any person aged18 or older in your household.
Source of Other Income
Other Income Amount
Total Household Income (Total of Items 17,18, 35, 36, & 37)
Household Information
Total # of people in household
Total # of children and their ages
Age and relationship of others who will be living in the house
Are you presently renting?
Clear selection
If yes, what is the location?
If yes, what is the monthly rent?
Do you own land?
Clear selection
If yes, what is the location?
If yes, what is the value?
Have either the applicant or co-applicant had a Bankruptcy ?
Clear selection
Have either the applicant or co-applicant had Judgements?
Clear selection
Have either the applicant or co-applicant had Collections?
Clear selection
If yes, please indicate a brief summary of the situation, date of occurrences and date paid.
The self-help program requires that each household contribute 35 hours per week performing home construction tasks. How many hours per week do you, the Applicant, plan to contribute?
How many hours per week do you plan to have the Co-Applicant contribute?
How many hours per week do you plan to have your friends contribute?
How many hours per week do you plan to have your relatives contribute?
Are you and your co-applicant able to perform the following common home construction tasks? (Hammering, lifting heavy objects, cutting lumber, climbing ladders, shoveling, painting)
Clear selection
Do you have reliable transportation available to get to and from the building site?
Clear selection
Are you able to provide consistent child care for your children while constructing the house?
Clear selection
Preferred Village
Please study the map below. Indicate with a check mark on the list below which zone(s) you would like to live in.

Guam's 19 Villages. Where would you prefer to live?
Application Procedure
Applications received in our office are reviewed for preliminary eligibility. If you are determined preliminary eligible based on the information you supplied, your application will be entered onto our waiting list. Being placed on our waiting list does not guarantee that you will be eligible for a self-help building loan. Applicants from the waiting list will be selected to participate in MCDC's housing programs based on the following criteria:

1.) Eligible income level
2.) Credit worthiness
3.) Desired area(s) indicated on application, and
4.) The date a completed application is received by MCDC.

When building lots become available in a specific area, applications are selected from those that have indicated a preference for that area on their application. Individuals are then contacted, according to the date when MCDC received each application. Although our waiting list is at times quite long, you will be contacted as soon as possible on a first come first serve basis within geographical areas chosen. If we are unable to contact you or you do not respond within a reasonable period of time, your application will be removed from our waiting list.

I hereby agree to keep Micronesia Community Development Corporation informed of changes in address, telephone, job status, or other conditions that may affect my application, and I understand that failure to keep MCDC informed of any changes in status may cause my application to be removed from the MCDC waiting list. I further certify that all of the information I have provided is accurate to the best of my knowledge. It is understood that the information disclosed on this form may be verified by MCDC for accuracy and/or used to obtain a credit report.
Digital Signature of Applicant (Please type your full name)
Date
MM
/
DD
/
YYYY
Digital Signature of Co-Applicant (Please type your full name)
Date
MM
/
DD
/
YYYY
This is an Equal Opportunity Program. Discrimination is prohibited by Federal Law. Complaints of discrimination may be filed with the administrator, RHS, USDA, Washington, DC20250-0700
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms