OPRHC West Cook Homeownership Programming Registration Form

The Oak Park Regional Housing Center

And the West Cook Homeownership HUD Program
Registration Form

Thank you for reaching out to Oak Park Regional Housing Center's West Cook Homeownership Program (WCHp), a HUD-approved, non-profit organization that offers FREE homebuyer education and counseling. Please complete this intake form to proceed with registration.

Gracias por comunicarse con West Cook Homeownership Center (WCHC), una organización sin fines de lucro certificada por HUD que ofrece asesoramiento GRATUITO. Complete este formulario de admisión para continuar con su registraccion.
Which of our programs are you interested in? If you are interested in registering for a second program, you will need to fill out and submit this form a second time to register.*

Second Saturday Homebuyer ClassHomebuyers ClubThe Credit and Debt Management ClassPost Purchase WorkshopRental WorkshopOther
Which class are you interested in? If you are interested in registering for two classes, you will need to fill out and submit this form a second time to register.*

Homebuyer Class, 9a-4pFinancial Education: Credit and Debt Management Class, 10aFinancial Education: Credit and Debt Management Class, 1pHomeowner Post Purchase Class, 10aHomeowner Post Purchase 1pRental Class 10aRental Class 1p
If you are looking to purchasing a home, what is your time frame to do so? Si está pensando en comprar una casa, ¿cuál es su plazo para hacerlo?*

1 - 6 Months6 Months or longerThis does not apply to me
Name / Nombre*

First NameLast Name
Please Note: If someone is purchasing this home with you, they will need to complete this form separately as well.

Si alguien va a comprar esta casa con usted, también deberá completar este formulario por separado.
If someone else is buying this home with you, please provide their name. / Nombre del Co-Prestario.

First NameLast Name
Relationship to Applicant / Relación con el solicitante
Address / Dirección *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone / Teléfono*

Area CodePhone Number
Email*
example@example.com
Date of Birth / Fecha de nacimiento*

MonthDayYear
Date
Gender identity / Identidad de género*

Male / MasculinoFemale / HembraPrefer not to respond / Prefiero no responderOther
Ethnicity / Etnicidad*

Hispanic/LatinxNon-Hispanic/LatinxPrefer not to respond / Prefiero no responder
Race / la raza*

White / BlancoBlack/African-American / Negro/AfroamericanoAsian / AsiaticoAmerican Indian/Alaskan Native / Indio Americano/Nativo de AlaskaNative Hawaiian or Other Pacific Islander / Hawaiana o isleña del PacíficoMore than One RacePrefer not to respond / Prefiero no responder
Education / Educación*

GED/High School / Escuela secundariaSome college / Alguna educación superiorAssociates / Grado AsociadoBachelors / LicenciaturaMasters / Professional Degree / MaestríaNo diplomaOther
Household Type:*

Female headed single parent householdMale headed single parent householdMarried without childrenSingle adultTwo or more unrelated adultsOther
Are you an active military member? / Militar Activo?*

Yes / SiNo
Are you a Veteran?

YesNo
Do you live in a Rural Area? / Vives en una zona rural?*

Yes / SiNoPrefer not to respond / Prefiero no responder
Do you identify as a person with a disability? / ¿Te identificas como una persona con discapacidad?*

Yes / SiNo
Marital status / Estado civil*

Single / SolteroMarried / CasadoWidowed / ViudoDivorced / DivorciadoSeparated / Apartado
Type of employment / Tipo de empleo*

Full-Time / Tiempo completoPart-Time / Medio tiempoSeasonal / Empleada de temporadaSelf-Employed / Trabajador independienteUnemployed / DesempleadosRetired / Retirado
Hire date / Fecha de contratación

MonthDayYear
Date
Please share your current annual household income / Ingreso anual del hogar *
TOTAL Yearly Income of Household
How many people in your household?
How did you hear about us? / Fuente de referencia*

Family/friend / Familia/amigoBank / BancoRealtor / Agente de bienes raícesHUD WebsiteWeb search / búsqueda de internetSocial mediaElected official / Funcionario electoCommunity Organization (type name in other box below)IFPN (Illinois Foreclosure Prevention Network)CCLAHD (Cook County Legal Aid for Housing and Debt)Other
Check here is you would like to receive text SMS reminders/updates about your registered class or upcoming classes.

Send me SMS reminders/updates
Disclosure

Oak Park Regional Housing Center, aka West Cook Homeownership Center is a nonprofit, HUD-approved, comprehensive housing counseling agency. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws. As a housing counseling program participant, you are not obligated to use the products and services of West Cook Homeownership Center or our industry partners.

As a nonprofit organization, we require this information to complete your registration. This information will not be shared with anyone.

Due to our classes being held vitually, by submitting this form you approve your digital image to be seen on our virtual platform.
Signature*

Clear
Should be Empty:

The Oak Park Regional Housing Center