HomeShare-Student-Interest

HomeShare OC Student Interest Form

Thank you for your interest in our HomeShare OC program. Please complete this form and we will contact you shortly.
Date*

MonthDayYear
Date
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
School Attending *
GPA*
In Good Standing*
Housing Needs*
Any previous drug/alcohol issues?*
Any evictions?*
Any mental health issues?*
Referred by:
HomeShare OC

Program Manager

714-993-5774

christopher@his-oc.org
Should be Empty:

HomeShare OC Student Interest Form