Pre-purchase Workshop Registration

IMPORTANT NOTES:

Please use this form for ONE person only. Each member of the household needs to register individually, if seeking a certificate.
Please provide the following information. It will only be used to issue a HUD certificate and to collect aggregate data required by our funders. Thank you for your cooperation.
You will receive a Zoom invitation to the workshop prior to the meeting.

First Name

Last Name

Address Line 1	City
State/Province Email Demographic and Other Information:	5-digit Postal/Zip code Phone # (w. area code)

Gender

Race

Ethnicity:

Preferred Language

English Language Proficiency Level

Educational Level

Marital Status

Employment Status

Number of MONTHS at current job

What is your total household ANNUAL income?

Household size

1234567 or more

Number of dependents

Applicant Role

Household Role

If head of household, which best describes you

Are you a veteran?

Are you disabled?

Are you a senior citizen (over 62)?

Do you live in a rural area?

How did you hear about us?

Please read the disclosure statement provided on the email or the website event listing and check the box to confirm you have read it. (http://www.fairhousingnorcal.org/disclosure.html)

Yes, I have read it.

I understand that I need to attend both workshop sessions in their entirety.

Yes

I understand that I need to participate in the class activities, break-out sessions and polls.

Yes

I am responsible for making any necessary arrangements (for example, childcare) ahead of time in order to attend the entire workshop.

Yes

I would like to receive your email newsletters.

Yes