Form Center Module

Welcome to City of High Point Form Center

Please fill out the following form. Once you have submitted the form, you will be redirected to a confirmation page.
By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress

Client Intake Form

Steps

  1. 1. Step One
  2. 2. Step 1 of 2

  • Step One

    2. Please type your first name.

    3. Please type your last name.

    5. Describe the service you are requesting.

    7. Select if you own or rent your home

    8. Household Income

      Please select your household income range.

    9. NC lighthouse

    13. Date & time your information is being submitted.