Member Information Form
This form is used by Habitat staff in order to invite you to our program through the my.americorps.gov system and send invitations to complete the background checks required for service.
Please direct questions to jlittle@iowahabitat.org or 515-266-6886
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Email *
Legal First and Last Name *
Preferred name
Address
City
State
Zip
Cell Phone number
Social Security Number
This is used to invite you to the My.AmeriCorps.gov system.
Date of Birth *
This is used to invite you to the My.AmeriCorps.gov system.
MM
/
DD
/
YYYY
T-Shirt Size *
All members receive Habitat for Humanity tshirts at the beginning of service.
Sweatshirt Size
If we have items available, Full time members will receive sweatshirts.
Clear selection
Emergency Contact- Name
Emergency Contact - Phone *
Emergency Contact- Address
Known Allergies *
A copy of your responses will be emailed to the address you provided.
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