Home Buyer Education – Course Sign Up Information

Neighbors Of Watertown, Inc. 112 Franklin Street ? Watertown, NY 13601

Phone: (315) 782-8497 ? Fax: (315) 782-0102

Home Buyer Education ? Course Sign Up Information

Head of Household

First Name

Last Name

Gender

Male

Female

Co-Head of Household

Male Female

Address

Address

City

State

Zip

County

Home Phone:

Cell Phone:

Total # in Household Ethnicity: (Select only one)

Gross Annual Income for Household Statistical Data

Race: (Select only one)

Hispanic or Latino

American Indian or Alaska Native

Not Hispanic or Latino

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Do you live in subsidized housing?

Yes

No

Do you receive HUD rental assistance?

Yes

No

Are you on the waiting list for HUD rental

Yes

No

assistance?

How did you hear about this class?

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