Home Relief Bank Expression of Interest

Please Complete the form below

Name of Organization

Address of Organization

Contact First Name

Contact Last Name

Contact Email Address

Contact Phone

Does your organization currently connect people to housing?

Does your organization have the means to disperse and collect monies?

Please describe the system you have in place to track demographic information on the people who will be receiving loans for statistical purposes

In what capacity does your organization work with populations that are precariously housed?

How will a Home Relief Bank complement your current programming?

Is there any other information about your organization that you would like to tell us?

Do you wish to attend the Home Relief Bank Information session on November 20th from 2pm to 3pm?