I understand that by submitting this request for information I am authorizing Habitat for Humanity to evaluate my need for a Habitat home repair, my ability to pay for the repair, and my eligibility for the Brush with Kindness Program. I understand that this request for information is a preliminary step, and is not a formal application. If I decide to proceed into the program, I am still expected to fill out an application. I understand when submitting an application that a credit report and criminal background check will be completed on all adults in the household. I understand that upon review of the application, credit report and criminal background check that I may not be accepted into the program. I have answered all above questions truthfully. Furthermore, it is understood that completion of this form does not guarantee that I/we will receive services through Habitat for Humanity of Dane County.