Parkview Home Buyer Registration Form
Fill out the form carefully for registration
Class Date
*
Please Select
1/9/2021
1/23/2021
2/6/2021
2/27/2021
3/13/2021
4/24/2021
5/8/2021
Participant Name
*
First Name
Middle Initial
Last Name
Gender
*
Please Select
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
Race
*
Please Select
-American Indian or Alaskan Native
-American Indian or Alaskan Native & Black or African American
-American Indian or Alaskan Native & White
-Asian
-Asian & White
-Black or African American
-Black or African American & White
-Choose not to respond
-Native Hawaiian or other Pacific Islander
-Other
-White
Ethnicity
*
Please Select
-Hispanic
-Non-Hispanic
-Prefer not to say
Total Monthly Household Income
*
Estimated Amount
Number of People in Household
*
Including Yourself
Additional Comments
Submit Application
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