Testimonial Form

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Testimonial Form

Provide your Testimonial

If you have partnered with or received assistance from KHRC, we’d like to hear from you! Please complete the form below to share your experience. If you are willing to grant permission for us to share your story with our stakeholders, please provide your consent at the bottom of the form.

If you have a concern about KHRC, our staff or partners, the programs we administer, or suspect fraud, waste, or abuse, please report it via our ethics form.

We appreciate your feedback!

Name(Required)

First Last

Phone(Required)

Address

Email(Required)

Do you wish to remain anonymous?

Yes

Which KHRC program did you apply to or partner with?

What prompted you to get involved with KHRC?

What was the application process like?

What was your experience like with our staff during the application process?

How has partnering with or receiving assistance from KHRC impacted your work or your life?

What would you say to others who could benefit from KHRC programs??

Additional Comments

Are you available to be contacted by the media if they have additional questions?(Required)

Yes

Electronic Signature

Full Name

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Household Size	Maximum Income for Weatherization (200% of FPL)
1	$ 25,760
2	$ 34,840
3	$ 43,920
4	$ 53,000
5	$ 62,080
6	$ 71,160
7	$ 80,240
8	$ 89,320

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