Housing Counseling Group Education Registration

Page 1

Group Session Related Information

Group Session Name

Group Session Date

Applicant Information

Provide details for the Primary Applicant below. The Primary Applicant will be the main contact. It is not required that the Primary Applicant be the most significant contributor to the family income. If there is a Co-Applicant, another household member that will be a co-borrower or co-owner, please include their details also.

Primary Applicant

First Name

Last Name

Date of Birth

Please enter your date using the ##/##/#### format. Please note that you must enter a 4 digit year.

Preferred Language

Contact Information

Email Address

If you don’t have an email, please enter noemail@noemail.com.

Home Phone

Please use this format: 555-555-5555

Preferred Phone

Mobile Phone

Please use this format: 555-555-5555

Work Phone

Please use this format: 555-555-5555

Mailing Address

Mailing Address Street Name/PO Box Number

City

State

Zip Code

County

Is there a Co-Applicant?

YesNo

Co-Applicant

Co-Applicant First Name

Co-Applicant Last Name

Co-Applicant Date of Birth

Please enter your date using the ##/##/#### format. Please note that you must enter a 4 digit year.

Co-Applicant Contact Information

Co-Applicant Email

Co-Applicant Phone

Please use this format: 555-555-5555

Is Co-Applicant's address the same as the primary applicant?

YesNo

Mailing Address

Mailing Address Street Name/PO Box Number

City

State

Zip Code

County

Page 2

Household Size

Please list the total number of household members including yourself.

Gross Annual Household Income Amount

Please list your household's annual gross income including all sources from all family members.

Applicant Credit Score (if known)

Co-Applicant Credit Score (if known)

Page 3

Current Living Situation

Outline information about your current housing and expenses on this page.

What best describes your current living situation?

Current Housing Payment (rent or mortgage)

First-time Homebuyer?

YesNo

Marital Status

Is there a person with special needs in the household?

YesNo

Please describe any special needs or accommodations required by your household for counseling

Is everyone in your household fluent in English?

How did you hear about the program?

Demographic Information

Demographic information is not a criteria in the approval process but provides a clearer picture on the types of families who might benefit from affordable housing opportunities. If you do not feel comfortable responding, you can elect the option "Prefer not to respond"

Applicant Demographics

Applicant Gender

Applicant Race

Applicant Ethnicity

Applicant Educational Attainment

Active Military

Veteran

Co-Applicant Demographics

Co-Applicant Gender

Co-Applicant Race

Co-Applicant Ethnicity

Co-Applicant Educational Attainment

You're all done! Once you hit the submit button below, you will not be able to go back and change any of your responses.