Personal Profile Intake form for housing - Isuroon

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Personal Profile Intake Form

Housing Pre-Reg form

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Full Name

Middle Name

Last Name

Email

Address

City

State

Zip Code

Country

Is there another person you would like to add?

Yes

No

Full Name

Middle Name

Last Name

Address

City

State

Zip Code

Country

Individual #1 Please continue

1. How did you hear about us?

Mailer, Flier, or Brochure

Newspaper

Agency

Friend or Relative

Internet

Realtor

Someone who took a workshop

Lender/ Mortgage Co

Other

Name here

2. Have you received financial services from any other agency? (Credit repair, Financial literacy, etc.)

Yes

No

If yes, please note the type and length of services:

Race (Select one)

American Indian/ Alaskan Native

American Indian/ Alaskan Native & White

Asian

American Indian/ Alaskan Native & Black

Black or African American

Asian & White

Native Hawaiian or other pacific Islanders

Black or African American & White

White

Native Hawaiian/ Other pacific Islanders & Black

Other race

If others, Specify

Main Office (Minneapolis)

1600 East Lake Street, Suite 1 Minneapolis, MN 55407
(612) 886-2731
(612) 345-5268
communications@isuroon.org

Burnsville Office

1103 Burnsville Parkway, Suite 203 Burnsville, MN 55337
(952) 595-5731
dakota@isuroon.org

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