Change Report Form

Change Report Form
Per your Partnership Agreement, any changes to your household composition and/or financial circumstances must be reported within 48 hours of becoming aware of the change.

Use this form to report any updates that may affect your Habitat program eligibility, status, or standing.

Once submitted, a member of the Homeowner Services team will review the information provided and follow up with you regarding any additional documentation, information, or next steps that may be required.
Name

First NameLast Name
Email
example@example.com
I am reporting a change in...
Please give SPECIFIC information as to the change you are reporting. For example, "I am receiving a 2% raise beginning September 1, 2026. Letter is attached.":
Date Change Became or Will Become Effective

MonthDayYear
Date
Please attach any documentation, as applicable, regarding the reported change. For example, updated SSI/SSD amount letter, or documentation of increased income due to a raise.

Cancelof
Should be Empty: