Contact Us

Jackie Spence
180 S Soangetaha Rd, Ste 108
Galesburg, IL 61401
FAX: 309-342-1768

Online Forms & Surveys

Project Rebound Application

The following is an application for Project Rebound. Please complete one for each adult living in the household. All information shared will remain confidential.

* First Name
* Last Name

*Marital Status

* Date of Birth
* Social Security #
* Home Phone/Cell Phone
Work Phone
Where do you live?
* Current Address
* City
* State
* Zip Code

*Currently living

* Number of adults in the household
* Number of children in the household (list ages and sex)
* Number of years you have lived at this address
* Current rent per month $
* Who will move into the new home with you?

*Were you ever evicted?
Previous Address - Please complete if you have lived less than 2 years at your current address.
Previous Address
Previous rent per month $
Work History - Where do you work?
* Name of Employer
* Number of years you have worked here
* Position/Job Title
* Monthly Gross Income $
* My family's monthly gross income (Include Social Security, Disability, Child Support, Alimony, Wages, Earned Income Tax Credit & any other income for all wage earners) $
Previous Employer: Please fill out if you have worked less than 2 years at current employment.
Name of Previous Employer
Number of years you worked there
Monthly Gross Income at Previous Employer $
Your Finances

*Is your credit good or repairable?

*Do you have any liens or judgements against you?
If yes, please provide details

*Will you live in this home?

*Do you own another home?

If you own another home, is it foreclosed on?

*Do you have to pay alimony, child support or maintenance?

*Have you ever declared bankruptcy?
If you have declared bankruptcy, when?

*Is your name on any loans?
If your name is on loans, please provide information.
Bank Information
* Name of Bank

*Type of bank account(s)

Please list a current balance for each account.

*Do you have additional assets? (Retirement Account, 401K, Automobiles)
If yes, please provide details:

*Are you a US Citizen?

If no, what is your visa status?


*I understand that a workable credit history is one the requirement for being approved to buy a house under Project Rebound. I hereby give my permission for Project Rebound to obtain a credit report for the purpose of evaluating my credit worthiness and ability to pay for a Project Rebound Home.
Project Rebound may call you for more documented information.
* Please type your name and date as a signature:

*Indicates questions that require an answer.