Webinar
Registration Form
If you have registered for a
CHT webinar within the last
six months, you can email
education@getahome.org
to register for this or any webinar.
Please tell us about yourself.
First Name
Middle Initial
Last Name
Birthdate
Gender
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What is your Marital Status?
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Were you born in a Foreign Country?
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Are you actively serving in the military
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Are you a Veteran?
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What is your Household's Primary Language?
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Education
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What is the Street Number of your Residence (numbers only)
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In which state do you reside?
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What is the Zip Code of Residence?
Is your mailing address different from your physical address?
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Second address (if needed)
Mailing Street
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AR
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CT
DE
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HI
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KY
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ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
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TN
TX
UT
VA
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Which is your preferred email address?
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**
Please note
if you need an accommodation or a support person to attend with you please contact our office to make the necessary arrangements. – education@getahome.org or 861-7394 **
Is someone else registering for the webinar with you?
Yes
No
Co-Registrant (if applicable)
First Name
Last Name
Birthdate
Mobile Phone Number
Personal Email
Webinar Registration
Webinar Selection Registrant #1
Fair Housing and Tenant Skills
Thursday, April 21, 7:00 PM
Webinar Selection Registrant #2
Fair Housing and Tenant Skills
Thursday, April 21, 7:00 PM
HOUSEHOLD INFORMATION (We need to know who is living in your home.)
Is anyone else living with you in this household? (Do NOT include yourself or any other webinar attendee listed above.)
Yes
No
Additional Household Member
Household Member Name
Household Member Birthdate
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is anyone else living with you?
Yes
No
Second Additional Household Member
Household Member Name
Household Member Birthdate
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is anyone else living with you?
Yes
No
Third Additional Household Member
Household Member Name
Household Member Birthdate
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is anyone else living with you?
Yes
No
What is your Living Situation
Rent
Own
Live with others
Homeless
Lease Purchase
other
Do you live in a CHT Property?
No
CHT Renter
CHT Co-op
CHT Homeowner
Define your Household type
Single Adult
Female-headed single parent
Male-headed single parent
Married-No dependents
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Two or more unrelated adults
Other
Is anyone in your household disabled or have special needs?
Yes
No
Gross Annual Income (Combine the income of all members in your household)
Please enter a number without any commas.
Referred By
Another Person
Another Agency
Real Estate Agent
Lender
Agency Outreach
HUD Outreach
Other
I have read Champlain Housing Trust's
Privacy Policy
&
Conflict of Interest Statement
.
Yes
Payment
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