A Mutual Self-Help Housing Program is being considered for rural Davidson or Rutherford County. You could own your own custom built home by participating in this program. The first step for participoation in this program is to complete and file this questionnaire.





         Your name: First Last

         Your e-mail address, if any:

         Street

         Rt./P.O. Box Number

         City

         State

         Zip

         Home telephone: area code number-

         Work telephone: area code number-

         What age group are you in?
         61 or Over:
         50-61
         35-49
         25-35
         18-25

         Marital status:
         Single:
         Married
         Widowed
         Divorced or Separated

         Number of persons in your household

         Number of Adults


         Males

         Females

         Number of Children

         Males

         Females


         Are any members of your household handicapped or impaired and in need of specially designed          housing arrangements? :
         Yes
         No

         If "Yes," please describe:
         

         What was the total combined annual income for all members of your household in 2000?
         Include all sources (wages, Social Security, pensions, public assistance, investments, etc.)?:
         $5,000 - 10,000
         $10,000 - 15,000
         $15,000 - 20,000
         $20,000 - 25,000
         $25,000 - $30,000
         Over $30,000

          Where do you presently live?:
         House
         Apartment
         Mobile Home
         Room
         Other

         Do you presently:
         Rent
         Own
         Live with someone else

         9. Describe your present housing condition:
         Adequate
         Delapidated
         Over Crowded
         Other

         Are you interested in home ownership?:
         Yes
         No

         Have you ever tried to buy a house?:
         Yes
         No

         Have you owned a house in the last 3 years?:
         Yes
         No

          Would you be willing to help build your house to help reduce your cost?:
         Yes
         No

         Would you be willing to join a group of families building their houses together?:
         Yes
         No

         What is your monthly rent or mortgage payment, excluding utilities?          

         If this program is started, would you like to be notified?:
         Yes
         No

          What is the biggest housing problem in your town/county?:

         

         Form completed by:          Date:          



         Submit this form from this page or print, complete, and return it to:

         Bishop A. E. Harris
         Abundant Living Community Outreach
                and Non-Profit Housing Corp.
         2597 White's Creek Pike
         Nashville TN 37207
         615 226 1717 ext 3
         
         or

         Carl Wright, CEO
         Visions Five Group
         1908 21st Ave S
         Nashville TN 37212
         615 383 3042
         visionsfive@yahoo.com
         

         Please add any comments you have below: