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HEART Survey Questions
Please fill out the questions below if you are interested in participating in Shelter of Flint's HEART initiative to furnish homes for recently housed clients.
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* Indicates required question
*
Your answer
Organization Name (if applicable)
Your answer
Address, City, State, ZIP
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Yes! I/We have HEART and would like to help an individual or family establish a home. Please add me/us to the list!
I/We will furnish a home for an individual
I/We will furnish a home for a family
Clear selection
If you would like to furnish a home for a family, please select a family size.
2
3
4
5+
Other:
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Preferred month(s)
January
February
March
April
May
June
July
August
September
October
November
December
Other:
Do you have any questions for us?
Your answer
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