EmailMeForm
Application for Partnership
Here is this year's application for "Habitat for Humanity" home-buyer program. Please fill it out completely.
All applicants must attend an information session before their application will be processed.
Habitat for Humanity houses are offered to qualified purchasers without regard to the purchaser's race, color, age, religion, sex, national origin, disability or familial status.
1
2
3
4
5
6
...
▶
1
2
3
4
5
6
7
8
9
10
Last Name of Applicant
*
Last Name of Co-Applicant
Today's Date
*
MM
/
DD
/
YYYY
APPLICANT INFORMATION
Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Date Of Birth
*
MM
/
DD
/
YYYY
Main Phone
*
###
-
###
-
####
Alternate Phone
###
-
###
-
####
Email
Please choose one:
*
Married
Separated
Unmarried (single, divorced, widowed)
Citizenship
*
If you are a US Citizen, please provide your AK Driver's License/ID #
If you are a Permanent Resident, please provide your Alien Registration #
I/we need Interpretation/Translation service for the following language:
*
Co-APPLICANT INFORMATION
Name
First
Last
Relationship to the Applicant
Address IF Different from the Applicant
Street Address
City
State / Province / Region
Postal / Zip Code
Date of Birth
MM
/
DD
/
YYYY
Primary Phone
###
-
###
-
####
Email
Alternate Phone
###
-
###
-
####
Please choose one:
Married
Separated
Unmarried (single, divorced, widowed)
Citizenship
If you are a US Citizen, please provide your AK Driver's License/ID #
If you are a Permanent Resident, please provide your Alien Registration #
Others who would live with the applicant/co-applicant in the Habitat house
First and Last Name
Relationship to Applicant
Date of Birth
Age
Male/Female
1
/
10
