Intake Form

Intake Form

Fall 2025 Program
Personal Information
Name

First NameLast Name
Date

MonthDayYear
Date
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Household Information
Total Adults in Household
Total Children (≤ 17) in Household
Children Information
Eligibility Questions
Are you married?
Do you own a home?
Financial Information
Annual Gross Income
Current Rent Amount
Lease Expiration Date

MonthDayYear
Date
Current Credit Score
Employment Duration at Current Job
Years
Additional Months
Additional Information
How did you hear about TES?
Please specify how you heard about us
Your Story
Upload Photo

Cancelof
T-Shirt Size
Your Social Media Platform
Your Social Media Handle
Applicant Acknowledgement
"I confirm the information is accurate. If selected, I agree to comply with the program requirements."
Should be Empty:

Household Information