Basics Of Buying A Home
Interest Form
Thank you for signing up for our program. By completing this form you are registering for the Basics of Buying a Home class on:
Please select...
Wednesday, April 10, 9:30 AM - Online via the Zoom Website
Wednesday, May 8, 6:00 PM - Online via the Zoom Website
Tuesday, June 4, 9:30 AM - Online via the Zoom Website
Thursday, July 18, 6:00 PM - Online via the Zoom Website
Please provide the following so we can register you for Basics of Buying a Home.
First Name
Middle Initial
Last Name
What is the Street Number of your Residence (numbers only)
What is the name of the street you live on?
If you have an Apartment Number or Apartment letter please list here. (if applicable)
What is your City of Residence?
In which state do you reside?
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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
We will use email to contact you. **
Referred by
Champlain College
Working Bridges
Vermont State Housing Authority
Burlington Housing Authority
Winooski Housing Authority
Americorps VISTA
CHT Website
Other
Demographic Information
CHT is pleased twe can provide this service/program to you for free. We can do this because we've received a grant from a funder to cover the costs. In order to keep this a free service/program, please provide the following information.
Birthdate
Gender
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Male
Female
Transgender
Other
What is your Marital Status?
Please select...
Single
Married/Domestic Partner
Separated
Divorced
Widowed
What is your Race?
Please select...
American Indian/Aleut/Eskimo/Alaska Native
Asian
Black/African American
Caucasian/White
Native Hawaiian/Pacific Islander
Multiple Race
Race Not Listed
Chose not to respond
What is your Ethnicity?
Hispanic
Not Hispanic
I choose not to respond
Are any other members in your household Black, Indigenous, People of Color? (BIPOC)
Yes
No
What races/ethnicities live in your household. Please select all that apply.
American Indian/Aleut/Eskimo/Alaska Native
Asian
Black/African American
Caucasian/White
Native Hawaiian/Pacific Islander
Hispanic/Latino/Latina/Latinx
Race not listed
Were you born in a Foreign Country?
Yes
No
Do you speak English fluently?
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
Are you actively serving in the military
Yes
No
Are you a Veteran?
Yes
No
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
HOUSEHOLD INFORMATION (We need to know who is living in your home.)
Is someone else in your household attending the class?
Yes
No
Co-Applicant (if applicable)
First Name
Last Name
Birthdate
Mobile Phone Number
Personal Email
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
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
Household Member
Household Member First Name
Household Member Last 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
Household Member
Household Member First Name
Household Member Last 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
Household Member
Household Member First Name
Household Member Last 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
Household Member
Household Member First Name
Household Member Last 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
Household Member
Household Member First Name
Household Member Last 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
Household Member
Household Member First Name
Household Member Last 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
Household Member
Household Member First 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
Household Member
Household Member First Name
Household Member Last 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
Household Member
Household Member First Name
Household Member Last Name
Household Member Birthdate
What is their relationship with you?
Child
Spouse
Non-married Partner
Other Relative
Not Related
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.
Acknowledgement
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