Repair Voucher Interest Form

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This form let's us know who might be interested in participating in the voucher project as a volunteer, as someone needing a voucher, and as a business who might want to participate by fixing items. We are at the beginning of creating this project, so any and all questions are very helpful.

Email *

What is your full name?

If you would like to include your phone number as an additional way to be contacted, please enter it here:

What is your preferred method to be contacted? *

Phone

Text

Any

Other:

Required

I am interested in volunteering with this project

Yes

Maybe

Clear selection

I am interested in receiving a repair voucher to get an item(s) fixed

Yes

Maybe

Clear selection

I am interested in participating as a repair business/receive repair vouchers

Yes

Maybe

Clear selection

What questions do you have about the voucher program?

Please provide more details of what is interesting about this project for you or what you are hoping for (i.e. What items would you like fixed? What kinds of things would you like to help with? What kinds of repairs could you offer? etc.):

Please include any/all questions you have about this project:

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