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INTAKE
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CONTACT
FAQs

HOME
ABOUT
INTAKE
PROGRAMS
RESOURCES
- Free Home Inspections
DONATE
- Sponsors
CONTACT
FAQs

HOME
ABOUT
INTAKE
PROGRAMS
RESOURCES
- Free Home Inspections
DONATE
- Sponsors
CONTACT
FAQs

Intake Form

The first step in participating in any RiseUp Fund offering is to complete the Intake Form. This information will be kept confidential and once shared, you can sign up for any of our other programs.

Name *

First

Last

Email *

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

What is your gender? *

Male
Female
Non-binary/Other
Prefer not to answer

What is your race? *

Black or African American
Hispanic or Latino
American Indian or Alaska Native
Caucasian
Hawaiian or Other Pacific Islander
Prefer not to answer

What is your marital status?

Married
Single
Divorced
Domestic Partnership

Are you a single parent? *

Yes
No

Which RiseUp Fund Program(s) are you interested in utilizing? *

Homebuyer Education Series
Home Purchase Financial Assistance
Homeowner Mentorship
Post-Purchase Homebuyer Education

Have you successfully completed a Homebuyer Education Program within the past 2 years?

Yes
No

If yes, please upload your completion certificate

Click or drag files to this area to upload. You can upload up to 2 files.

Have you ever owned a home before? *

Yes
No
Yes, but more than 3 years ago

How many people live in your household (including children and dependents)?

Selected Value: 0

Which household income range do you fall in? *

1 Person: $24,100 - $64,250
2 People: $27,550 - $73,400
3 People: $31,000 - $82,600
4 People: $34,400 - $91,750
5 People: $37,200 - $99,100
6 People: $41,960 - $106,450
7 People: $47,340 - $113,800
8 People: $57,520- $121,150
Prefer not to answer/don't know

What is your current estimated savings? *

Under $1000
$1000 - $3000
$3000 - $5000
$5000 - $7500
More than $7500
Prefer not to answer/don't know

What is your current credit score? *

Under 590
590 - 630
630 - 670
670 - 710
Above 710
Prefer not to answer/don't know

Why do you want to be considered for this program? *

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