Ready, Set, Rent!
Interest Form
By completing this form you are registering for the Ready, Set, Rent! class on:
Please select...
Wednesday, June 14, 9:30 AM - 12:00 PM
Monday, July 11, 6:00 PM - 8:30 PM
Thursday, August 10, 9:30 AM - 12:00 PM
Wednesday, September 6, 6:00 PM - 8:30 PM
Please tell us about yourself.
First Name
Middle Initial
Last Name
Birthdate
Gender
Please select...
Male
Female
Transgender
Other
What is your Marital Status?
Please select...
Single
Married/Domestic Partner
Separated
Divorced
Widowed
What is your Race?
Please select...
Caucasian/White
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
More than one race
Race not listed
Choose not to respond
Hispanic, Latino, Latina, or Latinx
What is your Ethnicity?
Hispanic
Not Hispanic
I choose not to respond
Are any members in your household Black, Indigenous, People of Color? (BIPOC)
Yes
No
What races/ethnicities live in your household. Please select all that apply.
Caucasian/White
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
More than one race
Hispanic, Latino, Latina, or Latinx
Race Not Listed
Were you born in a Foreign Country?
Yes
No
What is your Household's Primary Language?
Please select...
English
Arabic
Armenian
ASL
Bosnian
Cantonese
Mandarin
French
French Creole
German
Greek
Gujarati
Hindi
Hmong
Italian
Japanese
Korean
Napalese
Other
Persian
Polish
Portuguese
Russian
Somali
Spanish
Tagalog
Urdu
Vietnamese
Cambodian
Czech
Indonesian
Swahili
Turkish
Ukrainian
Unknown
Do you speak English fluently?
Yes
No
Are you actively serving in the military
Yes
No
Are you a Veteran?
Yes
No
We can offer you the Ready, Set, Rent! class via an appointment with an interpreter present. Do you need an interpreter?
Yes
No
What language should the interpreter be fluent in?
Please select...
Arabic
Armenian
ASL
Bosnian
Cambodian
Cantonese
Czech
French
French Creole
German
Greek
Gujarati
Hindi
Hmong
Indonesian
Italian
Japanese
Korean
Mandarin
Napalese
Persian
Polish
Portuguese
Russian
Somali
Spanish
Swahili
Tagalog
Turkish
Ukrainian
Unknown
Urdu
Vietnamese
WE WILL CONTACT YOU to schedule an appointment in your language. DO NOT attend the class listed above as it is English only!
Education
Please select...
Less than High School Diploma
High School Diploma or equivalent
Some Post-High School Education
Certification from a Vocational or Technical Training Program
Associate's Degree
Bachelor's Degree
Master's or other Graduate Degree
What is the Street Number of your Residence (numbers only)
What is the name of the road you live on?
Do you have an Apartment Number or Apartment letter? (if applicable)
What is your City of Residence?
In which state do you reside?
Please select...
VT
AL
AK
AZ
AR
CA
CO
CT
DE
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
VA
WA
WV
WI
WY
What is the Zip Code of Residence?
Is your mailing address different from your physical address?
Yes
No
Second address (if needed)
Mailing Street
Mailing City
Mailing State
Please select...
VT
AL
AK
AZ
AR
CA
CO
CT
DE
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
VA
WA
WV
WI
WY
Mailing Zip
Phone Number
Do you receive text messages on this phone?
Yes
No
Contact Email
**
Please note
Email is the quickest and most effective way for us to reach you. **
Is someone else listed in your application required to attend the class?
Yes
No
Co-Applicant (if applicable)
First Name
Last Name
Birthdate
Mobile Phone Number
Personal Email
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 the co-applicant (if applicable) listed above.
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
Is anyone else living with you?
Yes
No
Household Member
Household Member First Name
Household Member Last Name
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
Is this additional household member required to attend the class?
Yes
No
What is your Living Situation
Rent
Own
Live with others
Live with family rent-free
Homeless
Lease Purchase
Other
Define your Household type
Single Adult
Female-headed single parent
Male-headed single parent
Married-No dependents
Married-with dependents
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.
Checking "Yes" below serves as my signature that I have been given access to and have read Champlain Housing Trust's
Privacy Policy
&
Conflict of Interest Statement
.
Yes
Contact Information