Testimonial Form Home Testimonial Form Provide your Testimonial If you have received KHRC assistance, we’d like to share your story in our blogs and social media posts. Please fill out the form below with consent to share either anonymously or by name. Thank you for your contributions! Name(Required) First Last Phone(Required)Address Email(Required) Do you wish to remain anonymous? Yes Which KHRC Program did you apply to? What prompted you to apply?What was the application process like?What was your experience like with our customer service team during the application process?How has receiving these funds impacted your life?What would you say to others who could benefit from the program?Additional CommentsAre you available to be contacted by the media if they have additional questions?(Required) Yes No Consent(Required) I hereby grant permission to the Kansas Housing Resources Corporation (KHRC) to use my name, and the information about my circumstances that I have provided in this testimonial, in KHRC's sole discretion provided herein. I assign all rights to the information to KHRC. I understand that KHRC may use my name and this information in educational or promotional materials to assist fellow Kansans and that KHRC will not use it for any commercial (profit-making) purpose. I acknowledge and hereby waive any privacy interests I may have in this information under the Privacy Act, 5 U.S.C. 552a, the Freedom of Information Act, 5 U.S.C. 552, and the Trade Secrets Act, 18 U.S.C. 1905. I hereby release the State of Kansas, KHRC, and its Board of Directors, officers, employees, agents, and insurers, from any and all liability resulting from the use of my name and/or this information.Electronic Signature Full NameCAPTCHAEmailThis field is for validation purposes and should be left unchanged.