Home Ownership Sign Up Form

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Housing Interest Sign-up Form

Get notified for new projects. When Greater Middlesex & Morris Habitat for Humanity starts a new project, we notify people on our distribution list of the project so they can come to the information session to learn about the project and apply for the home. We will also share information from partner organizations; for example we would share information regarding tax preparation or other affordable housing opportunities.

First Name**

Last Name**

Email Address**

Address, line 1

Address, line 2

City

State

Cell Phone

Zip Code

How you heard about the program

Please provide information about yourself and your current housing conditions

Please tell us about the people who will be living in the home:

Enter information about the children under 18 in your home:

Total household members*

Number of boys under 18*

Number of girls under 18*

Number of adults*

Ages of boys*

Ages of girls*

Does anyone in the household have special needs requiring accessibility features?

Yes No

Special Needs Description

Please tell us about yourself:

Are you or someone in the household veterans of the US Armed Forces?

Yes No

Are you a permanent resident of the United States of America?*

Yes No

Do you have a regular income of at least $35,000 annually for your total household? **

Yes No

Additional_Comments

Current Housing Conditions:

Overcrowding

Yes No

Inadequate

Yes No

Unaffordable

Yes No

Unsafe Conditions (Elec, Plumb, Struct)

Yes No

Unsafe Neighborhood

Yes No

We will never share your email address. Ever.

Thank you for signing up.

We'll send you a confirmation email shortly.

Please check the SPAM or JUNK folder of your email if you do not receive a message in your INBOX.

We can't wait to start building our partnership!

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