You've Got This! Sign-Up

Please note: This is not a sign-up for our Home Journey Housing Counseling Program. By filling out this form, you agree to have Habitat Omaha send you educational material regarding homeownership. This is NOT a loan application or a guarantee of a loan for a Habitat for Humanity of Omaha house.

First Name

Last Name

Street

City

Zip Code

State

Phone Number

Email Address

What is your gender identity?

Employment type:

Have you lived in the Omaha Metro area for the past 12 months?

Would you feel comfortable communicating with Habitat Omaha staff in English?

What is your preferred language?

Are you a U.S. Citizen or Permanent Resident (Green Card Holder)?

YesNo

Which race do you identify as?

Which ethnicity do you identify as?

Are you an immigrant to the U.S.?

If you are an immigrant to the U.S.

How long have you lived in the U.S.?

Country of origin (Nationality)

I acknowledge and give permission to be corresponded with via email or through phone communication from the staff at Habitat Omaha.

I agree and accept the terms and conditions of this questionnaire

Contact Information