Dream Achievers Request For Services

Dream Achievers Resource & Development Center is a 501(c)(3) charitable organization. We believe that everyone deserves access to housing and economic stability.

Please complete this questionaire and someone from our team will contact you as soon as possible.
Name*

First NameLast Name
Help finding housingDebt/Credit Counseling MortgageForeclosure help/Mortgage RescueFood assistanceAges 16-22 T.O.R.I. ProgramJob/Career/Education NavigationNot sureOther
HomelessLiving in a HotelLiving in a temporary shelter arrangement, such as with a friend or in a shelter?None of the above
NoneUp to 5th Grade6th - 9th10th-12thHigh School DiplomaSome CollegePost Secondary DegreeRefusedUnknownOther
UnemployedDisabledFixed IncomePart -TimeFull-timeOther
Police OfficerFirefighterActive MilitaryVeteranSenior CitizenNone of these
Please state your annual household income*.*
*Annual Household Income is the combined earnings for one year of all adults sharing a residence.
How many ADULTS are in your household?*
How many CHILDREN (0-18) are in your household?*
Age of children if applicable:
YesNoMaybeType option 4
YesNOEnrolling soon
MaleFemaleOtherDo not wish to answer
American Indian/Alaska NativeAsianBlack or African AmericaMulti-RacialNative Hawaiin/Other Pacific IslanderWhiteRefusedUnkown
YesNoRefused
Please provide your email address: If you don't have access to email type NONE
example@example.com
Please provide the number you would like us to call you at.*

Area CodePhone Number
How did you hear about us?*
Is there anything else you would like us to know?
YesNo
Should be Empty: