Housing Counseling Application

Housing Counseling Interest Form

Thank you for your interest in one-on-one housing counseling with Magnolia Medical Foundation. Please take a few moments to let me know us know about you and your goals! One of our housing counselors will follow up with you shortly.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email Address *
example@example.com
Best times to reach you? *
Preferred Method of Communication
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please mark the type of housing counseling you are seeking. (Check All That Apply)

Foreclosure Prevention Financial Literacy Home Pre-Purchase Home Post-Purchase Tenant's Rights Landlord's Rights Fair Housing Banking Down Payment Programs Homelessness Affordable Housing Budgeting Credit Counseling Rental Counseling Lease Agreements Financial Scams
We currently offer virtual housing counseling on weekdays and select Saturdays. Please list the general dates and times that you will be available for housing counseling services (ex. Mondays & Wednesdays 3-8 pm). *
What are 1-3 housing goals you want to achieve in the next 3-6 months? *
How motivated and ready do you feel to start working on your goals? (5 is the most motivated) *
How did you hear about our services? *
We offer our housing counseling services at no cost to the community. Please provide the names and contact of those that you believe would like to refer to benefit from our services.
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Housing Counseling Interest Form