HomeForever

Registration Form

A Guide to Successful Home Ownership

This is a “Home Safe” Course

This course fulfills Soft Second Post Purchase Class requirement and is also required for discounts with some home insurance companies

Three night series

Tuesday and Thursday evenings 6 – 8:30 PM

$25 Fee to cover the cost of the manual (checks may be made to HAC)

Please check the series you will attend

___February 7, 9, 14, 2012 (Tuesdays & Thursday)

___April 3, 5, 10, 2012 (Tuesdays & Thursday)

___June 5, 7, 12 2012 (Tuesdays & Thursday)

___October 9, 11, 16, 2012 (Tuesdays & Thursday)

Participant(s) Name: (please print) ______

Address______

City______State______Zip Code ______

Home Phone______CellPhone______Email______

Number of people in household: adults______children:______

Number attending this workshop______

I own a: Single Family____Condo____Other____ (Please specify) ______

Current Mortgage Company______

Do you have a Soft Second loan? ______

Insurance Company______Annual Insurance Premium $______

Do you have a Home Equity Loan or Line of Credit? ______

Have you refinanced since owning your home? ______

How long have you owned your home?______

Are you a first generation Homeowner?______

Do you think you will need a loan in the future to do repairs/rehab on your home? ______

As a homeowner, what kind of problems/issues have you dealt with since buying your home? ______

______

Is there a topic of interest or maintenance project you would like information on during this workshop or any future workshop? ______

______

How did you hear about this workshop?______

For office use only: payment received: cash ______check#______mo#______

Please send this registration form to

HCEC – Housing Assistance Corporation

460 West Main Street, Hyannis, MA02601

A confirmation letter will be sent prior to class

Attendance at all 3 nights is required for certification

For additional information about the workshop, please call Cheryl (508) 771-5400 x287

HAC receives funds from various sources for counseling services and we are required to collect certain data. We also use the information we collect to evaluate our workshops and learn more about the people we are serving. The information collected from this form is completely confidential.

Name: / Name:
1. Age:
_____ 20-30 years
_____ 31-40 years
_____ 41-50 years
_____ 51-60 years
_____ 60+ years / 1. Age:
_____ 20-30 years
_____ 31-40 years
_____ 41-50 years
_____ 51-60 years
_____ 60+ years
2. Gender: Male____ Female _____
3. Veteran? Yes_____ No _____
4. Disabled? Yes_____ No_____
5. Are you the Head of the Household?
Yes_____ No _____ / 2. Gender: Male____ Female _____
3. Veteran? Yes_____ No _____
4. Disabled? Yes_____ No_____
5. Are you the Head of the Household?
Yes_____ No _____
6. Ethnicity:
______Hispanic/ Latino
______Non Hispanic/ Latino
* For Census 2000, there are two categories for ethnicity: Hispanic or Latino and not Hispanic or Latino. The federal government considers race and Hispanic origins to be two separate and distinct concepts. Hispanics and Latinos may be of any race. (Source: / 6. Ethnicity:
______Hispanic/ Latino
______Non Hispanic/ Latino
* For Census 2000, there are two categories for ethnicity: Hispanic or Latino and not Hispanic or Latino. The federal government considers race and Hispanic origins to be two separate and distinct concepts. Hispanics and Latinos may be of any race. (Source:
7. Race: (please select one)
Single Race Categories
_____ American Indian or Alaskan Native
_____ Asian
_____ Black or African American
_____ Native Hawaiian or Other Pacific
Islander
_____ White
Multi-Race Categories
_____ American Indian or Alaskan Native
and White
_____ Asian and White
_____ Black or African American and
White
_____ American Indian or Alaskan Native
and Black or African American
_____ Other Multiple Race
8. Have your parents or grandparents ever owned a home in the U.S.?
Yes _____ No _____ / 7. Race: (please select one)
Single Race Categories
_____ American Indian or Alaskan Native
_____ Asian
_____ Black or African American
_____ Native Hawaiian or Other Pacific
Islander
_____ White
Multi-Race Categories
_____ American Indian or Alaskan Native
and White
_____ Asian and White
_____ Black or African American and
White
_____ American Indian or Alaskan Native
and Black or African American
_____ Other Multiple Race
8. Have your parents or grandparents ever owned a home in the U.S.?
Yes _____ No _____
9. Where were you born?
_____ U.S.
_____ U.S. Territory (e.g., Puerto Rico)
_____ Other Country: ______/ 9. Where were you born?
_____ U.S.
_____ U.S. Territory (e.g., Puerto Rico)
_____ Other Country: ______
10. Highest Level of Education Completed:
______Less than high school graduate
______High School Diploma/ GED
______2-year college
______Bachelor’s Degree
______GraduateSchool/ Post
Secondary Degree / 10. Highest Level of Education Completed:
______Less than high school graduate
______High School Diploma/ GED
______2-year college
______Bachelor’s Degree
______GraduateSchool/ Post
Secondary Degree
11. Have you seen a copy of your credit report in the last year?
Yes ______No ______/ 11. Have you seen a copy of your credit report in the last year?
Yes ______No ______
12. Do you know your credit score?
Yes ______No ______/ 12. Do you know your credit score?
Yes ______No ______
Household Information
13. Household Size:
Number of Adults: ______Number of Children ______
14. Annual Household Income:
______$20,000 and below
______$20,000 to $30,000
______$30,000 to $40,000
______$40,000 to $50,000
______$50,000 to $60,000
______$60,000 to $70,000
______$70,000 to $80,000
______$80,000 to $90,000
______$90,000 to $100,000
______$100,000 plus