Mailing Address:
P.O. Box 3615
Little Rock, AR 72203
Application for Membership
Agency Name
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Address
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Phone Number
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Contact Person:
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E-mail Address
Website:
Age of Agency
*
Less than 1 year
1-3 years
4-6 years
7-10 years
over 10 years
Employee Staff Size
Volunteer only
1-3 employees
4-6 employees
7-10 employees
over 10 employees
Annual Operating Budget
Less than $200,000
$200,000 --$350,000
$350,001--$500,000
$500,001 to 1 million
over 1 million
Organization Type: (check all that apply)
501©3 Non-profit
Public Housing Authority
Community Housing Develop. Org. (CHDO)
Faith-Based organization
Affiliation(s)
HUD Approved Counseling Agency
ADFA Approved Homeownership Counseling Agency
LISC
NeighborWorks America
Mission of Hope
List other affiliations here
Certification(s)
HUD Approved Counseling Agency
NeighborWorks America Training the Trainer
NeighborWorks America Housing Counseling
AHECI
List other certifications here
Housing-related programs your agency participates in: (check all that apply)
Owner-occupied rehab
Down payment assistance
Housing counseling
Weatherization
Homebuyer education
Acquisition and Rehab
New construction (single family)
Financial Management Classes
New construction (multi-family)
Self-Help Housing
Your role with the organization: (check all that apply)
Housing Counselor
Homebuyer Educator
Rehabilitation Specialist
Executive Director/President
Board Member
Housing Director
List you other roles in your organization here
Why are you interested in becoming part of ACHANGE:
Areas of Interest: (check all that apply)
Housing Counseling certification program/standards
Homebuyer Educator certification program/standards
Regional workshops
Public policy
Management training
Mentoring opportunities
list other areas of interest here
In applying for membership, I agree with the mission of ACHANGE and will do my part to improve the quality of housing and life of Arkansas residents.
Electronic Signature
(enter your name)
A signed agreement will be required up approval.
*
Title
*
Date:
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Security Code
For security purposes, enter the 6 characters listed in the field to the right.
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Mailing Address: