Cabarrus County Homebuyer Forum Survey

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* 1. Participant Information - Please include First and Last name

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Co-participant Information - Please provide First and Last Name

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Do you have a contract to purchase a house?

Yes

If yes what is the estimated closing date:

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* 4. Are you currently working with a realtor?

Yes

Name and contact information:

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* 5. Are you currently working with a lender?

Yes

Name and contact information:

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* 6. Marital Status:

	Married	Divorced	Separated	Never Been Married	Widowed	Domestic Partner
Participant	Participant Married	Participant Divorced	Participant Separated	Participant Never Been Married	Participant Widowed	Participant Domestic Partner

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* 7. Marital Status:

	Married	Divorced	Separated	Never Been Married	Widowed	Domestic Partner
Co-Participant	Co-Participant Married	Co-Participant Divorced	Co-Participant Separated	Co-Participant Never Been Married	Co-Participant Widowed	Co-Participant Domestic Partner

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* 8. Do you need to schedule a one-on-one counseling session? Please Read This Carefully - NOTE: This is a requirement if you would like to be assess for down payment assistance funds, WeBuild or need help in finding the right lending institution that meets your situation.

The counseling will also assess your mortgage and homeownership-readiness and give you guidance on how to get to "Yes" from a lender.

Yes

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* 9. Number of people in your household:

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* 10. Date of Birth - Participant

Enter your birthdate:

Date

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* 11. Date of Birth - Co-participant

Enter your birthdate:

Date

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* 12. Which race/ethnicity best describes you? (Please choose only one.)

	American Indian or Alaskan Native	Asian/Pacific Islander	Black or African American	Hispanic	White/Caucasian	Choose Not to Respond
Participant	Participant American Indian or Alaskan Native	Participant Asian/Pacific Islander	Participant Black or African American	Participant Hispanic	Participant White/Caucasian	Participant Choose Not to Respond
Co-Participant	Co-Participant American Indian or Alaskan Native	Co-Participant Asian/Pacific Islander	Co-Participant Black or African American	Co-Participant Hispanic	Co-Participant White/Caucasian	Co-Participant Choose Not to Respond

Multiple ethnicity / Other (please specify)

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* 13. What is your citizenship status? (Please choose only one.)

	US Citizens	DACA	Permanent Resident Alien
Participant	Participant US Citizens	Participant DACA	Participant Permanent Resident Alien
Co-Participant	Co-Participant US Citizens	Co-Participant DACA	Co-Participant Permanent Resident Alien

Other (please specify)

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* 14. Rural Area Status:

	Household lives in a rural area	Household does not live in a rural area
Participant	Participant Household lives in a rural area	Participant Household does not live in a rural area
Co-Participant	Co-Participant Household lives in a rural area	Co-Participant Household does not live in a rural area

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* 15. Ethnicity Type:

	Hispanic/Latino	Not Hispanic/Latino	Choose Not to Answer
Participant	Participant Hispanic/Latino	Participant Not Hispanic/Latino	Participant Choose Not to Answer
Co-Participant	Co-Participant Hispanic/Latino	Co-Participant Not Hispanic/Latino	Co-Participant Choose Not to Answer

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* 16. Limited English Proficiency Status:

	Household is Limited English Proficiency	Household is not Limited English Proficiency
Participant	Participant Household is Limited English Proficiency	Participant Household is not Limited English Proficiency
Co-Participant	Co-Participant Household is Limited English Proficiency	Co-Participant Household is not Limited English Proficiency

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* 17. Preferred Language

	English	Spanish
Participant	Participant English	Participant Spanish
Co-Participant	Co-Participant English	Co-Participant Spanish

Other (please specify)

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* 18. Employment Information - Participant

Name of Employer:

Yearly Income:

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* 19. Employment Information - Co-Participant

Name of Employer:

Yearly Income:

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* 20. Acknowledgement: I am aware that this is an introduction to the homebuying process and not the REQUIRED Homebuyers Education Course or THE companion course required for down payment assistance.

	Agree
Participant	Participant Agree	Participant
Co-Participant	Co-Participant Agree	Co-Participant

Other (please specify)

Cabarrus County Homebuyer Forum

Section 1: Registration

Question Title

* 1. Participant Information - Please include First and Last name

Question Title

* 2. Co-participant Information - Please provide First and Last Name

Question Title

* 3. Do you have a contract to purchase a house?

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* 4. Are you currently working with a realtor?

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* 5. Are you currently working with a lender?

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* 6. Marital Status:

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* 7. Marital Status:

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* 9. Number of people in your household:

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* 10. Date of Birth - Participant

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* 11. Date of Birth - Co-participant

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* 12. Which race/ethnicity best describes you? (Please choose only one.)

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* 13. What is your citizenship status? (Please choose only one.)

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* 14. Rural Area Status:

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* 15. Ethnicity Type:

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* 16. Limited English Proficiency Status:

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* 17. Preferred Language

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* 18. Employment Information - Participant

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* 19. Employment Information - Co-Participant

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* 20. Acknowledgement: I am aware that this is an introduction to the homebuying process and not the REQUIRED Homebuyers Education Course or THE companion course required for down payment assistance.