Interest Form

Please review the Apply for a Home web page to ensure you meet our guidelines before submitting this form to HFHMC. Please note that this Interest Form is NOT an application for a Habitat home, but enables us to pre-qualify you. If you are within our guidelines, you will be invited to apply during the next open application period.

YOU MUST FILL OUT THE ENTIRE FORM IN ORDER FOR US TO PRE-QUALIFY YOU.

*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
Email Address:

Would you like to subscribe to our email list?

No thanks.

Yes, please subscribe me.

Home Phone:
Cell Phone:
Work Phone:

*Are you:

Married

Separated

Divorced

Widowed

Single (never married)

*How many people are in your household?
*How many children or others living with you are 18 or older?

Please list your monthly income from any of the following (we MUST have this information to be able to tell you whether or not you qualify):
Job- Average Hours Per Week:
Job- Hourly Rate:$
Family Assistance:$
Food Stamps:$
Social Security:$
SSI:$
Disability:$
Alimony:$
Child Support:$ [actually received]
Other:$ [describe below]
Other income description: