Homeowner Application Workshop Registration Form

Verde Valley Habitat for Humanity works with all applicants on an individual basis.

By filling out this form, you are registering to attend the Homeowner Application Workshop.  We will call you to schedule your attendance upon receiving this completed form.

Name (Required)

Physical Address

State

Zip

Mailing Address

State

Zip

Email (Required)

Home Phone and/or Cell Phone (Required)

How many family members will be living in the home?

Have you lived in the Verde Valley for at least 12 consecutive months?

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