Westside Home Ownership Readiness Assessment

First name

Last Name

Email address:

Current Address

Current City

State

Zipcode

Mobile

Home Phone:

Graduate of a Westside Works Program

Yes

Are you a current client of Integrity?

Yes

Educational Level

Please select... Non High School Graduate High School/GED Some College College Graduate Advanced Degree

Current Housing Status

Please select... Renter Home owner

Currently Employed

Yes

If employed, length of employment

Please select... 12 months or less More that 12 months 2 years or more

Current Debt

Please select... $10,999 or below 11,000 -$30,9999 $31,000 - $49,999 $50,000 or above

Annual Income

Please select... Less than $10,000 $10,000 - $29,999 $30,000 - $49,999 $50,000 - $69,999 $70,000 or more

Last 4 Digits of Social Security Number

Credit Score

Please select... Poor Good Excellent

Online link to access free credit report:    http://www.annualcreditreport.com

Date