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Apartment, suite, etc. (optional)
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Co-Applicant information

First name

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Last name

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Phone

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Phone type
Email address

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Email type

Address

Address

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Apartment, suite, etc. (optional)
City

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Country/region

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State

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ZIP code

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Background

Languages

Please fill out the following information to learn more about our Critical Repair program.

Applicant
Co-Applicant

Type of building:

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Are you the home owner?

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Are you the legal owner of the home?

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Is the home located in Yakima County?

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Are you a citizen or permanent resident?

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Household information:

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Are you a Veteran?

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Number of members in the Household:

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Type of repairs needed:

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Description of repairs:

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How did you learn about Yakima Valley Partners Habitat for Humanity's Critical Repair Program:

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