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Complete the form below to begin the application process for a low-interest home improvement loan from Renew Alameda County. Once you submit it, a staff member from Habitat for Humanity East Bay/Silicon Valley will contact you to share the official full application form.

This program only serves homeowners in the California Bay Area. Please do not fill out this form if you are located outside of this area.

Request For Service Form: This is an initial interest form for you to express your interest in the program and is not considered a full application.

This program only serves homeowners in the California Bay Area. Please do not fill out this form if you are located outside of this area.

Section 1. Homeowner Information

First Name

Last Name

Gender

Race (optional)

Ethnicity (optional)

Section 2: Contact Information

Street

State

City

Zip Code

Primary Phone

Format 999-999-9999

Is the primary contact different than the homeowner?

Primary Contact Info

If the Primary Contact is someone other than the Homeowner, please provide their contact info below:

Who is the Primary Contact?

Other - Description

Preferred Method of Contact

Primary Contact Name

Relationship to Homeowner?

Primary Contact Address

Primary Contact Phone

Format 999-999-9999

Phone Type

Primary Contact Email

What is your preferred language?

Other Language

If English is not your preferred language, is there an English speaker who can help with the application process as needed (e.g. family member, friend, neighbor)?

YesNo

Section 3: Homeowner Priorities

What are your top 4 priorities for repair?

Priority 1

Priority 2

Priority 3

Priority 4

How did you hear about Renew AC?

When you click submit below it may take a few moments. Please only hit the Submit button once. We’ll double check to make sure you have submitted all the necessary fields. When you've filled out any of the missing pieces, submit again.

Talk to you soon and thank you for taking the time to fill out out interest form.

Renew Alameda County