Confidential "Housing Needs SURVEY"

Full Name* This field is required.

Prefix

First Name

Last Name

Phone Number* This field is required.

Area Code

Phone Number

Phone Number and Text Authorization* This field is required.ONLY if you would like to receive Texts!

Area Code

Phone Number

EMAIL ADDRESS* This field is required.{Enter an Email that you check daily}

{If you do not have an email, ENTER N/A

Please select your Communication / Attendance Preference.* This field is required.Check all Housing concerns that you are requesting

Telephone Dial-In Only Workshops

URGENT One-on-One In-Person Session

URGENT Housing Telephone Session

Group Assistance Workshops that cover more than one financial topic

I do not have computer access and able to connect with an Advisor

I do not have computer access and/or home-bound, requesting a Home Visit Session with an Advisor

Other

Number in your Household* This field is required.

Age* This field is required.Current Age(s) of Home Buyer / Home Owner / Renter

HOME OWNERS* This field is required.Are you renting a portion of your home or have tenants?

YESNO

Housing Resolution Assistance* This field is required.{Check all that you are interested in below}

Avoiding Foreclosure on my Home Mortgage - A review of the possible Options

Avoiding Eviction and retaining rental unit - A review of all possible Options

How to avoid Property Tax Delinquency and Tax Sales

Building & Protecting my Home Equity

Financial: Budget / Credit Management

Learning the advantages of a Reverse Mortgage to help with monthly expenses

HOA Condo HOA Fees brought current

Review of your current REVERSE MORTGAGE

How you can use Reverse Mortgage for your Home Repairs -- Strategies and Grant Assistance

Get Ready to Purchase a Home - Be in a home with equity up to $100,000, within three weeks after becoming Mortgage Ready!

Talk with an Advisor regarding general Resources / Information

Learn how to avoid Probate and protecting the Deed to your Home

I am on SNAP and need assistance in navigating the risk to loose my benefits

Myself or a loved one is seeking assistance Mental Health & Substance Abuse information

Would like a clearer understanding of how to increase my monthly income using my home

Special concerns of Senior, Physically Disabled, Returning Citizen, Widow or Widower

Building Generational Wealth "Know the KEYS" - Leaviing property to Heirs!

Computer Lab Assistance needed

Important Documentation Concerns-- Birth/Death Certificates, Passports,Property Deeds, Tax Bills, etc.

Choose the Outreach /Open House Events/ Workshop Date and Time* This field is required.{If you do not have a computer, you can listen in on your home or mobile phone}

You will be registered for your Workshop selection and will receive a confirmation email or call.

Enter two days and times for a Telephone private one-on-one with an Advisor* This field is required.{ You will receive a response within 24 hours of your inquiry }

{Appointments are scheduled on Tuesdays and Fridays - For Urgent orTime-Sensitive matters, Evenings and Saturdays are available

I am Interested in Purchasing a HOME* This field is required.Are you a first-time Home Buyer? {Not owned a home in the past 3 years}.

YESNO

HOME BUYER - Where are you in the home buying process?* This field is required.{ Check as many that apply. Skip to next Section, if you are already a Home Owner}

Just Beginning my Home Buying Journey

Found My Home

Submitting an Offer to Purchase

I have a Closing Date: Received Lender Loan Commitment

Renting, but would like to learn how to become a Home Owner one day

Rebuild my Credit

Creating & Managing a Budget

Debt Management and Increase Savings to purchase a home

Want to find the best Lender for my home purchase

Other

RENTAL Assistance and Services{Select One}

Currently Renting a UnitSeeking a Rental Unit

List below any other questions about Budgeting / Credit / Home Buying or Home Ownership, Landlord or Rental, etc. that you would like to have addresssed?* This field is required.Type a Description Below or enter N/A

How did you hear about the Faith-Based Housing Alliance?* This field is required.{ FAITH IN ACTION- TOGETHER }

AGORA Housing Services: HUD-Approved Housing Adviser- Illinois

Pastor Lawrence Blackful: Southland Equity Initiative, St Bethel Temple

Bishop Roland T. Sanders: Prelate Illinois 3rd Jurisdiction, New First Church of God in Christ

Apostle Deborah Campbell-Smith: The Masters Touch Church

Pastor Robert R. Sanders: Redeemed Fellowship Outreach Ministries

Pastor Gordon Kindred: St. James Church of God In Christ

Vikki & Matthew Christmon: Mental Health & Drug Abuse Awareness Solutions

Carolyn whiteurst: Real Estate Broker

Brenda Sheriff: Heirship and Insurance and Investment Specialist

George Broustis: VP Senior Mortgage Solutions, Rate Reverse Lending NMLS#1961045

Atty. Ellen Deranian: Deranian Law, Probate and other real estate issues

Sanina Ellison : Real Estate Broker, Re-CHRG.Inc.

Other

Confidential "Housing Needs SURVEY"