Group Session Intake
Page 1 of 2
Class Name
Attendee
First Name
Last Name
Email
Phone
Phone Type
Please select...
Home
Work
Mobile
Street Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Is there a second person from your Household attending this session?
Please select...
Yes
No
Second Attendee
First Name
Last Name
Email
Session Details
Is this training required by your lender?
Please select...
Yes
No
Have you signed a purchase agreement?
Please select...
Yes
No
If yes, please provide the following details for the property you have agreed to purchase. If you don’t know leave blank.
Street Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Purchase Price
Loan Amount
Interest Rate
Closing Date
Lender
Before beginning the training, below are some questions to test your knowledge about purchasing a home. Please do your best to answer each question.
Which of the following loan options is recommended for a first-time homebuyer?
Adjustable rate
Contract for deed
Balloon
Fixed rate
Interest-only
PITI is a term commonly used in mortgage lending. What does it stand for?
Payment, Interest, Taxes, Insurance
Principal, Interest, Taxes, Insurance
Principal, Interest, Terms, Insurance
Payment, Interest, Terms, Insurance
What type of insurance is typically required for first-time home buyers?
Title insurance
Homeowners insurance
Private mortgage insurance
All of the above
Please consider each of the following statements about mortgage lending. Answer "Yes" if you believe the statement to be true and "No" if you believe it to be false.
A debt-to-income ratio of 43% or less is considered desirable.
Yes
No
Borrowers must have at least
two years
of continuous employment to qualify for a mortgage loan.
Yes
No
It is recommended that homeowners have savings
to cover 3 months of household expenses to weather unexpected income loss, emergencies, and repairs.
Yes
No
While you might qualify for a mortgage loan with a 580 credit score, a score of 640-680 can qualify you for which of the following?
More loan options
Favorable interest rate
More homebuying assistance programs
All of the above
Hidden Fields
Group Session ID
Owner ID
Owner Role/Agency Formula
Contact ID
Counseling/Education ID
Service File ID
Disclosure URL
IsLegacySubmission
TRUE
FALSE
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To demonstrate our commitment to equity and our service reach, we are required to collect demographic information from the clients we serve. Please answer the following demographic questions.
1.
What is your birth date?
MM/DD/YYYY
2.
What gender do you identify as?
Please select...
Female
Male
Trans female
Trans male
Trans non-binary
Non-binary
Other
3.
What is the highest degree or level of education you have completed?
Please select...
Less than HS Diploma
High school diploma or equivalent
Some post-secondary education
Certification from a vocational or technical training program
Associate's Degree
Bachelor's Degree
Master's or other graduate degree
4.
What is your
monthly household income
? (Include income from all sources including employment, child support, social security, pension, etc.)
Annual household income
5.
Are you a veteran?
Please select...
Yes
No
6. Are you active military?
Please select...
Yes
No
7.
Are you living with a disability?
Please select...
Yes
No
8.
Do you need language assistance or an interpreter
Please select...
Yes
No
9. What language do you primarily speak?
Please select...
English
Spanish
Somali
Hmong
Karen
Oromo
Amharic
Chinese - Cantonese
Chinese - Mandarin
French
German
Tagalog
Vietnamese
Italian
Korean
Russian
Polish
Arabic
Portuguese
Japanese
French Creole
Greek
Hindi
Persian
Urdu
Gujarati
Armenian
ASL
Cambodian
Czech
Indonesian
Swahili
Turkish
Ukrainian
Other
Chose Not to Respond
10.
What is your current housing arrangement?
Please select...
Renting
Owning
Staying with family or friends
Homeless
Staying in a Shelter
Other
11.
Do you live in a rural area?
Please select...
Yes
No
12.
How many adults live with you?
13.
How many children live with you?
14.
What is your current marital status?
Please select...
Single
Married / Domestic Partnership
Separated
Divorced
Widowed
Unknown
Chose Not to Respond
15.
What best describes your household type?
Please select...
Single Adult
Female-headed single parent household
Male-headed single parent household
Married/Domestic Partnership without dependents
Married/Domestic Partnership with dependents
Two or more unrelated adults
Other
16.
What is your race?
Please select...
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Other multiple race
Chose Not to Respond
16.1
What is the race of the other person you listed?
Please select...
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Other multiple race
Chose Not to Respond
17.
Are you Hispanic, Latino or Spanish origin?
Please select...
Yes
No
I choose not to respond
17.1
Is the other person you listed of Hispanic, Latino or Spanish origin?
Please select...
Yes
No
I choose not to respond
18.
Were you born outside of the United States?
Please select...
Yes
No
19.
Do you identify with any of the following immigrant or new American communities?
Please select...
No, does not apply
British/U.K.
Burmese (includes Karen and Karenni)
Cambodian
Canadian
Chinese
Dominican
Ethiopian
Filipino
German
Guatemalan
Haitian
Honduran
Hmong
Indian
Kenyan
Korean
Laotian
Liberian
Mexican
Nigerian
Oromo
Russian
Salvadoran
Vietnamese
Somali
Other
20.
Are you a first time homebuyer (you have not owned a home for the past 3 years)?
Please select...
Yes
No
21.
Are you a first generation homebuyer (your parents did not own a home)?
Please select...
Yes
No
22.
How did you hear about us?
Please select...
HUD Outreach
Agency Outreach
Another Person
Lender
Another Agency
Real Estate Agent
Other