HomeFit Intake FormHS 

PLEASE FILL OUT THE FOLLOWING FORM AND OUR INTAKE SPECIALISTS WILL FOLLOW UP AS SOON AS POSSIBLE

Basic information






















Household information

The following information will help us to understand your background, household make-up and potential program 

eligibility. It will in no way positively or negatively impact or influence the assistance we provide.





















Financial information

This basic information will help us get an initial picture of your current financial circumstances – we may seek additional information following the intake process so that we can better assist you with your goals.

Additional information