Eviction Defense Team

1

Let's start by first learning your name.* This field is required.

First Name

Last Name

2

Nice to meet you! What's a good email address for you?* This field is required.

example@example.com

Confirm Email

3

Great! What about a phone number? * This field is required.

Area Code

Phone Number

4

Anyone we should thank for introducing you to Heartland Center?

7

Are you currently a licensed attorney?

YESNO

8

A social worker?

YESNO

9

What about any other special skills, certifications, or degrees that would help us determine where you might fit in this program?

10

Okay, nearly done... What's your availability?Please include typical days and hours that you expect you may be available.

11

Anything else we should know?