Information Session Registration Form
Session Attendee 1
First Name
(Nombre)
Last Name
(Apellido)
Mailing Street
(Dirección)
City
(Ciudad)
State
(Estado)
Zip Code
(código postal)
Phone
(Número de Teléfono)
###-###-####
This is my
(este es mi número)
Mobile (cellular)
Home (casa)
Work (trabajo)
Email address
(Correo Electrónico)
Date of Birth
Race
Asian
Black/African American
American Indian/ Alaskan Native
Native Hawaiian
Pacific Islander
White
African Immigrant or refugee
Latino/Hispanic
Middle Eastern
Slavic
Declined to answer
Ethnicity
Hispanic
Not Hispanic
Chose Not to Respond
Gender
Male
Female
Transgender
Other
Enter information for a second person from your household who is attending the info session.
Yes
No
Household Member/Session Attendee 2
First Name
(Nombre)
Last Name
(Apellido)
Email address
(Correo Electrónico)
Date of Birth
Race
Asian
Black/African American
American Indian/ Alaskan Native
Native Hawaiian
Pacific Islander
White
African Immigrant or refugee
Latino/Hispanic
Middle Eastern
Slavic
Declined to answer
Ethnicity
Hispanic
Not Hispanic
Chose Not to Respond
Gender
Male
Female
Transgender
Other
Please contact me in the language below.
(Mandeme toda la información en el siguiente lenguaje.)
Please select...
English
Espanol
Chinese - Cantonese
Chinese - Mandarin
French
German
Tagalog
Vietnamese
Italian
Korean
Russian
Polish
Arabic
Portuguese
Japanese
French Creole
Greek
Hindi
Persian
Urdu
Gujarati
Armenian
ASL
Somali
Hmong
Which session would you like to attend?
¿Qué clase te gustaría asistir?
Sabado, Febrero 29 a las 10:30 AM, Proud Ground: 5288 N Interstate Ave. Portland, OR 97217
Saturday, February 29 at 12:30 AM, Proud Ground: 5288 N Interstate Ave. Portland, OR 97217
How did you hear about our program?
(¿Cómo te enteraste de nosotros?)
Please select...
Afr Amer Alliance for Homeownership
Church/Faithbased/Pastor
Community Presentations
Current Program Homeowner
Earned media - news articles, LTE, etc.
Employer
Event - Homebuyer Fair
Event - Other/non-spec.(ie. Street Fair)
Facebook
For Sale Sign
Friends/Family/Co-worker
Government Agency
Hacienda CDC
Head Start
Homebuyer education
Internet Search
Mailing
NAYA Family Center
Open House
Organizational Newsletter
Paid advertising - Neighborhood Specific
Paid advertising - newspaper/magazine
Paid advertising - other
Paid advertising - radio/TV
Paid advertising - Weekly (ie. Skanner)
Portland Housing Center
Poster/flyer
PSA - radio
PSA - television
Real estate listing - MLS
Refered by another ageny/non-profit
Refered by lender
Referred by real estate agent
Schools
Television
Website - Craigslist
Website - Organization
Website - Other/non specified
Word of mouth - Current/Past staff
Word of Mouth - general
Other
Please select the most recent way you heard about Proud Ground.
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Contact Information