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Intake form
Help us serve you better
Name
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Email address
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What is your current housing situation?
Select
Renting
Homeownership
Homeless
Living with family or friends
What type of assistance are you seeking?
Please select at least one option.
Affordable housing
Workforce development programs
Utility cost reduction
Financial literacy resources
How did you hear about building roots foundation?
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Social media
Word of mouth
Community event
Online search
Local news
What is your household size?
What is your monthly income range?
Select
Under $1,000
$1,000 - $2,500
$2,500 - $4,000
Over $4,000
Do you have any specific needs or preferences for housing?
Are you currently employed?
Select
Yes
No
What skills or training do you possess?
Would you be interested in participating in workforce development programs?
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Yes
No
Maybe
What is your preferred method of communication?
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Email
Phone
Text message
Additional questions or comments
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