Housing Interest Form Your Information First Name * Last Name * Street Address * City * We only service Harford and Cecil counties, MD County * State * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Email * Phone * Cell Phone * Household InformationHousehold SizeNumber of Adults (Over 18)Children's AgesMarital Status - select Marital Status - Married Separated Unmarried (Incl. single, divorced, widowed) Current Housing SituationIs your current housing temporary or transitional?Yes No Are there enough bedrooms for the head of household as well as for each sex child?Yes No List any structural or mechanical problems with your current home:List any other reasons that show your need for a Habitat home : How did you hear about us?How did you hear about us? Word of Mouth Church Housing Agency Other Agency Internet Newspaper, radio, TV Other Save Cancel