Interest Form

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Habitat for Humanity International is a Christian organization and welcomes volunteers from all faiths who are committed to Habitat's goal of eliminating poverty housing.

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Interest Form

Please review the Apply for a Home web page to ensure you meet our guidelines before submitting this form to ORGABBREV. Please note that this Interest Form is NOT an application for a Habitat home, but provides us with your contact information so that we can notify you when we have our Home Interest Meeting at which time you will receive an application.

*First Name:
*Last Name:
*Current Address:
*City:
*State:
*Zip:
A Permanent mailing Address
(if different from current address):

City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
*Alternate permanent phone number::
Email Address:

Would you like to subscribe to our email list?

No thanks.

Yes, please subscribe me.

*How many people under the age of 18 would live in the house?

*How many people age 18 or older would live in the house?

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Please answer these questions below about yourself only, if you are married you will be asked for your spouse's information below. Thank You.

*Do you have permanent residency status in the U.S.?

Yes

*What is your total income per year (just yourself's)? :

*In the past 12 months, List all the cities and states you have lived in::

*In the past 12 months, List all the cities and states you have worked in::

In the past 12 months, list the jobs you have had and the dates of employment for each.:

*Have you filed for bankruptcy within the past 3 years:

Yes

*Do you have any unpaid school loans?

Yes

*Do you have any unpaid judgments?

Yes

If applicable, are you current on payments of child support?

Yes

*Do you own any property?

Yes

*Are you married?

Yes. If yes, please do not submit form here, complete your spouse's information below submit button.

No, I am single. If single you may submit interest form now by clicking Submit button below.

No, I am divorced. If single you may submit interest form now by clicking Submit button below.

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If married please complete questions below.
If you are married, what is your spouse's name?

Your spouse's total income:

Does your spouse have permanent residency status in the U.S.?

Yes

In the past 12 months, List all the cities and states your spouse has lived in::

In the past 12 months, list all the cities and states your spouse has worked in::

In the past 12 months, list the jobs your spouse has had and the dates of employment for each.:

Has your spouse filed for bankruptcy within the past 3 years:

Yes

Does your spouse have unpaid school loans?

Yes

Does your spouse have any unpaid judgments?

Yes

If applicable, is your spouse current on payments of child support?

Yes

Does your spouse own any property?

Yes

We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status, national origin, age, marital status, or sources of income.

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