HomeSource Inquiry Form

HomeSource Inquiry Form

NeighborImpact HomeSource
NeighborImpact is an equal opportunity provider and employer. If you require accommodation, please contact 541-548-2380 or reception@neighborimpact.org. If you are hearing impaired, please dial TYY 711.

NeighborImpact es un proveedor y empleador que ofrece oportunidades de igualdad. Si necesita adaptaciones, llame al 541-548-2380. Si tiene problemas de audición, marque TYY 711.
This is an initial inquiry form. Programs & Service participation will require additional documents and some may have a fee.
In what language do you prefer to receive communications? / En que idioma prefiere comunicarse?*

EnglishEspanolOther
Puedes traducir este formulario utilizando el menu en la esquina superior izquierda
What is your top interest, goal, or concern? If there are more than one, you can indicate your top 3.*

I want to improve my financial life by reducing debt, improving my credit score, and/or increasing my savingsI want to become ready to rentI am behind on my mortgageI want to learn what I need to do to buy a homeI want to learn about your Matched Savings ProgramI am struggling to make my mortgage paymentsI am struggling to make my mortgage paymentsI need help to avoid foreclosureI want to get my reverse mortgage certificate
Do you have a secondary goal, interest or concern? If so, type your answer below. *
Name*

First NameLast Name
Preferred Pronoun
Date of Birth*

MonthDayYear
Date
Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you live within Bend City Limits?*

YesNo
In which county/reservation do you live?*

DeschutesCrookJeffersonConfederated Tribes of Warm SpringsOther
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you hear about our services?*

Other agency or organizationSocial mediaRadio/TVFlyer or signFriend or familyNeighborImpact websiteOther
What is your current housing situation?*

Experiencing homelessnessLiving with others, not paying rentRentHomeowner with mortgageHomeowner with mortgage paid offOther
Have you already taken one of our HomeSource workshops?*

YesNo
Explore our workshops on this page: https://homesource.as.me/schedule.php
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