KI Engagement Form - Kheprw Institute

Thank you for your interest in the Kheprw Institute. If you’d like to connect with our community engagement team, please fill out this form.

About You

First Name *(required) Last Name *
Company or Organization
What is your birthdate, so we can plug you in appropriately with our inter-generational approach?
If you are you already connected to anyone at Kheprw, who are they?
What interests, hobbies or passions do you have?
What are three personal or professional goals you have?

Contact Information

Email * Phone
What are your social media profiles?

Mailing Address

Street Address City State/Province
Zip

Would you like to meet with a member of our community engagement team?
What location or event are you completing this form from?
Would you like to subscribe to the Kheprw Institute mailing list?
What programs are you interested in learning more about?

Do you live in Marion County? Yes
Do you have a consistent source of income? Yes
Do you owe $20k-200k on your home? Yes
Is your credit score above 600? Yes