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Habitat for Humanity of Sonoma County
Program Interest Form

This is not an application for housing. The information you provide will

enable us to gauge your ability to serve you.

Status

Interested

First Name

Last Name

Phone

Mailing Address

Street

City

ZIP Code

Do you live at this address?

YesNo

What is the ZIP code of your residence?

If you are considering leaving Sonoma County due to lack of stable affordable housing, in what time-frame?

Not leaving6 months1 year2 years

Habitat for Humanity of Sonoma County
Program Interest Form

This is not an application for housing. The information you provide will
enable us to gauge your ability to serve you.

How many people are in your household?

12345678more than 8

Please review the above table and select the range that contains your income according to your household size.

Category 1Category 2Category 3

In the last 4 years, has any adult in your family had a foreclosure or a bankruptcy that has not been discharged?

YesNo

Do you own a home or have you owned a home within the last 3 years?

YesNo

Are Applicant and Co-Applicant (if applicable) U.S. Citizens, legal permanent residents, or legal work permit holders?

YesNo

Where do all original working household members work? (Check all that apply.)

Sonoma CountyMarin CountyNapa CountySolano CountySan Francisco CountyAlameda CountyContra Costa CountyMendocino CountyLake CountyOther

Additional Information

Habitat for Humanity of Sonoma County does not discriminate on the basis of race, color, national origin, religion, sex, age, family status or marital status, disability, sexual orientation, gender identity, or because all or part of income is derived from any public assistance program.

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Contact Information

Habitat for Humanity of Sonoma CountyProgram Interest Form

Habitat for Humanity of Sonoma CountyProgram Interest Form

This is not an application for housing. The information you provide willenable us to gauge your ability to serve you.

Habitat for Humanity of Sonoma County
Program Interest Form

Habitat for Humanity of Sonoma County
Program Interest Form

This is not an application for housing. The information you provide will
enable us to gauge your ability to serve you.