Homebuyer Education
Registration Form 2024
By completing this form you are registering for the Homebuyer Education Workshop on:
Please select...
ONLINE via ZOOM Tuesday & Thursday, August 13 &15, 5:30 PM-9:00 PM (you must attend both sessions)
ONLINE via ZOOM Tuesday & Thursday, September 17 & 19 5:30 PM - 9:00 PM ( you must attend both sessions )
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...
Asian
American Indian/Aleut/Eskimo/Alaska Native
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
Chose 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.
American Indian/Aleut/Eskimo/Alaska Native
Asian
Black/African American
Caucasian/White
Native Hawaiian/Pacific Islander
Hispanic/Latino/Latina/Latinx
Multiple Race
Race Not Listed
Chose not to respond
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
Have you ever owned a home before?
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
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
Mobile Phone Number
Do you receive text messages on this phone?
Yes
No
Home Phone Number (land line)
Which phone number is your Primary Phone?
Please select...
Home
Mobile
Personal Email
**
Please note
your fee entitles up to two people, who are purchasing a home together, to attend the workshop and receive counseling. If you need an accommodation or a support person to attend with you please contact our office to make the necessary arrangements. – education@getahome.org or 861-7394 **
Is someone else attending the workshop with you?
Yes
No
Co-Client (if applicable)
First Name
Last Name
Birthdate
Mobile Phone Number
2nd Person 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 any other workshop attendee listed above.)
Yes
No
First Household Member
Household Member 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
Second Household Member
Household Member 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
Third Household Member
Household Member 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
Fourth Household Member
Household Member 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
Fifth Household Member
Household Member 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
Sixth Household Member
Household Member 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
Seventh Household Member
Household Member 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
Eighth Household Member
Household Member 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
Ninth Household Member
Household Member 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
Tenth Household Member
Household Member 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
Homeless
Lease Purchase
other
Do you live in a CHT Property?
No
CHT Renter
CHT Co-op
CHT Homeowner
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.
Referred By
Another Person
Another Agency
Real Estate Agent
Lender
Agency Outreach
HUD Outreach
Other
Please tell us how you learned about this program.
Payment
Typing my name below is my signature that I have received and read Champlain Housing Trust's
Privacy Policy
&
Conflict of Interest Statement
.
I will participate in at least one individual counseling session in which I will review a credit report with a Counselor, receive help to determine my affordability, discuss applicable programs, and develop an action plan. (Note: you receive your completion certificate at this initial appointment)
Yes
I understand that if I do not attend the workshop I must contact CHT within 30 days. CHT will happily reschedule me for another workshop. I understand all workshop fees expire 6 months from date of submission. If I do not attend and do not contact CHT the fee is forfeit.
Yes
Enter DISCOUNT CODE (if applicable)
Payment Amount
You will NOT have the opportunity to enter a discount code after this point.
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You do not need a PayPal account, there is a "CREDIT CARD" only option. Thank you.
Contact Information