Homebuyer Education Intake Form

Thank you for registering for a Homebuyer Education class! Please fill out the below intake form prior to attending the class.

If you have questions, please call 520-318-0993.

Applicant and Co-Applicant Information

First Name	Last Name	Date of Birth	Gender

Address
Street Address Address Line 2 City State ZIP Code
Phone
Email*
Who were you referred by?
Number of people living in home to be purchased?
Do you currently rent or own your home?
- Rent
- Own
Marital Status
Do you live in a rural area?
- Yes
- No
Preferred language
- English
- Spanish
Educational Level
- College
- High School/GED
- Vocational
Applicant Info
(Information requested for reporting purposes)
Applicant is
- Female Head of Household
- First Time Home Buyer
Applicant Ethnicity
- Hispanic
- Not Hispanic
- American Indian/Alaskan Native
- Asian
- Black/African American
- Native Hawaiian/Pacific Islander
- White
- American Indian/Alaskan Native & White
- Asian & White
- Black/African American & White
- Amer Indian/Alaskan & Black
- Other
- Choose not to respond
Applicant Gross Monthly Income
Co-Applicant Info
(Information requested for reporting purposes)
Co-Applicant is
- Female Head of Household
- First Time Home Buyer
Co-Applicant Ethnicity
- Hispanic
- Not Hispanic
- American Indian/Alaskan Native
- Asian
- Black/African American
- Native Hawaiian/Pacific Islander
- White
- American Indian/Alaskan Native & White
- Asian & White
- Black/African American & White
- Amer Indian/Alaskan & Black
- Other
- Choose not to respond
Co-Applicant Gross Monthly Income