EmailMe Form - Submit A Family to PROJECT: H.O.M.E.

Are you submitting on behalf of a family? *

Yes

No

QUALIFICATIONS (You must check YES to every option to be eligible): *

I am able to show proof of ownership on mortgage statement

I am a legal resident of the United States

I am above the age of 18

There are no prior convictions in my household or restraining orders

I do not live in an apartment complex

My income is less than $30,000 yearly

I am the legal parent/guardian of any minor children included on my application

I acknowledge, represent and warrant that the foregoing representations and warranties hereinabove also apply to each member of my family applying to participate in Project: H.O.M.E.

NAME *

First Last

Occupation (Head of Household): *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone *

### - ### - ####

Email *

Insert all Social Media links: *

Twitter, Facebook, YouTube, etc.

Insert names and ages of additional family members:

If none, leave blank.

Tell us a little about the family and/or individual in need of a refurbished home. Please be detailed. *

If submitting on behalf of a family and/or individual, how do you know them?

Describe the living conditions. Why should this home be refurbished? *

Does the family own the property? You must submit proof if selected. *

Yes

No

A short YouTube video is also suggested to include with your application, but is
not required. Post the link below: *

Insert any further comments below:

I HEREBY CERTIFY THAT ALL OF THE INFORMATION PROVIDED ABOVE AND IN THE APPLICATION IS TRUE AND COMPLETE. I UNDERSTAND THAT ANY FALSE STATEMENT OR MATERIAL OMISSION BY ME MAY LEAD TO MY DISQUALIFICATION FROM PARTICIPATION IN THE PROGRAM AND/OR THE PARTICIPANT SELECTION PROCESS FOR THE PROGRAM. *

Agreed