Required Information

First Name *

Last Name *

Email *

Phone *

Preferred Pronouns *

She/Her

He/Him

They/Them

What is your preferred language? *

Preferred Method of Contact

Phone Call

SMS Text

Street *

City *

Zip Code *

State *

Catalyst Miami's programs and services aim to prioritize those with an income that falls at or below the income level indicated in the chart below.
Given your family size, does your income fall at or below the amount on the chart below? *
Your answer to this question will not guarantee or prevent your participation in our programming.

Income Chart

Optional Demographic Information

To understand why we collect all of this data, please click here.

When were you born?

What race do you identify with?

What ethnicity do you identify with?

What gender do you identify with?

What is your employment status?

What is your current health insurance status?

Household size, including yourself *

Annual Household Income *

What’s your current living situation?

What type of home do you live in?

Please share any information you think might help us better serve you (for example, best time to contact you, any special accommodations you need, or a brief information about your services needs)

After you click Submit, you will receive an email with next steps. We will contact you as soon as possible. If you haven't heard back from us within a week, please send an email to [email protected], or call us (or text us) at (786) 744-5079.

*If you are also interested in assistance with financial coaching, health insurance, or public benefits enrollment, please click here to request an appointment.

By submitting this intake form, you are OPT-IN and are consenting to receiving SMS text messages from Catalyst Miami for appointments, events and general outreach purposes at any time while inquiring about or receiving services. Message frequency may vary. You may reply STOP to opt-out of future messaging at any point. Reply HELP for more information. Message and data rates may apply.

We do not rent, lease, or sell customer lists or any data collected on our site to third parties. Catalyst Miami does not sell, share, or lease personal information with third parties for marketing/promotional purposes.

Click here to see our Privacy Policy.

"By submitting this request for services, I attest that the information I am providing is true and correct."

Thank you for your interest in Catalyst Miami's services! Please complete the following form.

Required Information

Optional Demographic Information

Free Insulation Installation

Free Insulation Installation

Free Insulation Installation

Thank you for your interest in Catalyst Miami's services! Please complete the following form.