Pre-Intake Survey

Thank you for contacting the NELCDC! We have a few questions we need to ask so we can determine how best to serve you!

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Date of Call / Inquiry *

Name *

First

Last

Email *

Phone *

Address *

City *

State *

Zip Code

How did you hear about the NELCDC? *

• A Friend
• A Lender
• Other Source

Name of Lender

Other Source

What would you like to achieve working with NELCDC? *

• Purchase of a Home
• Refinance
• Improve my Credit
• Home Equity Loan
• Financial Independence
• Foreclosure / Loss Prevention
• Fair Housing Inquiry / Complaint
• Other

Other

Have you taken NELCDC's Financial Literacy / Homebuyer Education Workshop *

• Yes
• No

If yes, what month and year?

When is the best day(s) for you to meet with a Housing Counselor? You may specify more than one day. *

• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• Sunday
• Daytime (8am-5pm)
• Lunch Hour
• Evenings
• Weekends
• Other

Other Times

Please specify a best time to meet.

Do you have other availability specifics or special needs?

Please specify a best time to call. *

Confirm cell phone number *

Would you like to receive text from NELCDC to remind you of your appointment? *

• Yes
• NO

Is a referral necessary? *

• Yes
• No
• I don’t know.

If Yes, provide details.

Submit

Thank you for this information.  We will provide this information to our housing counselor.  Someone will call you back to schedule an appointment, go over the paperwork needed, and tell you the next steps to get started! Thank you for allowing the North & East Lubbock CDC to serve you and help you meet your goals!