First Name *

Last Name *

Gender Female Male Non-binary Prefer not to say Something Else

Birthday

Email *

Phone 1 *

Preferred Contact Method * Email Phone Text

Which housing opportunity are you interested in? (Check all that apply) *

What are some places that you might contribute?

Additional Skills

Monthly Household Income *

Size of household (include yourself) *

Do you have a co-applicant? Yes No

Bedroom Size Preference *

What other housing needs do you have?

Please list any additional housing needs here.

What is your general availability for an orientation?

Would you like to provide demographic information?

What is your race? (Check all that apply)

Which best describes your ethnicity?

Are you a person with a disability? Yes, I have a disability, or have had one in the past No, I do not have a disability and have not had one in the past Decline to Answer

Have you or a family member ever served in the military? (including active duty service members)

What is your co-applicant's age?

What is your co-applicant's race? (Check all that apply)

Which best describes your co-applicant's ethnicity?

Which best describes your co-applicant's gender? Female Male Non-binary Something else Prefer not to say

Given the choice, would you like to do more work for longer in order to have a new house or would you rather work less and have a used house? I'd be happy with a used house sooner I'd work more for a new house

Tell us about you and why you’re interested.

How did you hear about us? Flyer Radio Ad Website Word of mouth Common Roots Volunteer Facebook Google

Would you like added to the Common Roots email list?