Habitat for Humanity of Elkhart County, Inc., to which you have shown interest in applying, has been the recipient of financial assistance through the State of Indiana and the US Department of Housing and Irban Development (HUD). As part of program requirments, both the total number of beneficiaries created and the number of low-to-moderate income beneficiaries must be reported. This information is confidential; however, it is subject to verification by authroized government officials. THIS FORM IS NOT AN APPLICATION; it is a tool for Habitat to use in the future application process. (A family is comprised of persons related by blood, marriage or adoption who live with you. Do not count emancipated children and their dependents).