HSDCNC Homebuyer Education Course Sign-up Form

Lexington Office: 21 W. 2nd St. Lexington, NC 27292

Thomasville Office: 10 Salem St. Thomasville, NC 27360

Office Phone# (336) 236-1675 Office Fax# (336) 236-9408

Email: miriam@hsdcnc.org
Homebuyer Education Course

Registration Form
Client/Account Information
Full Name*
Birth Date*

MonthDayYear
Phone Number*
Format: (000) 000-0000.
Current Mailing Address*

Street Address

Lot #, Apartment #, etc.,

CityState / State / County

Postal / Zip Code
Email*
example@example.com
Preferred Language*
English, Spanish, French, German, etc.,
If you've been pre-qualified then by who?*
agency, bank, realtor or lenders info
OwnRentLease-to-OwnOther
Length of Occupancy at current residence:*
YesNo
Current Monthly Rent/Mortgage Payment:*
Put 0 if none
Number of Dependents?*
children, parents or other family
If you have found a home you are interested in then what is the address?*
street, city, state, zip
YesNo
YesNo
YesNo
Rental IncomeSocial Security Benefits (SSI or SSD)Retirement/Pension/VAChild Support or AlimonySelf-employmentEarned wages or salaryMonthly assistance from friends or familyMonthly assistance programs (food benefits, Work First)Weekly assistance programs (unemployment)This household has ZERO income!
Information for Government Monitoring Purposes Only!

The following information is requested by the Federal Government for certain types of loan applications related to dwelling, in order to monitor compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to fill out this information but are encouraged to do so.
Marital status?
Gender?
Ethnicity Type?
Citizenship(s)?
Race?
Veteran/Military?
Disabled?
Highest Level of Education?
YesNo
Do you receive alimony?
Do you receive child support?
Total amount of child support and/or alimony received? (If applicable)
Employer/Income Source:
Position/Title:
Number of hours worked per week?
Income amount?
Pay Frequency?
Why are you interested in participating in this course? What are your expectations?

Please be as detailed as possible. 0/400
What questions would you like answered during this course?

Please be as detailed as possible. 0/400
What is the best timeframe to contact you?

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
If using a mobile device then please use your finger or stylus for your signature.*

Clear
Date and time of submittal

MonthDayYear
DateHourMinutesAM/PM Option
That's it for now! Just hit submit below if you are finished or save to continue later. Thank you for inquiring about our Homebuyer Education Course. Your information will be reviewed as soon as possible and you should receive a response within 3-5 business days. If you need further assistance then please call our office Monday-Friday between 9:00am-5:00pm at 336-236-1675.
Should be Empty:

Lexington Office: 21 W. 2nd St. Lexington, NC 27292

Thomasville Office: 10 Salem St. Thomasville, NC 27360

Homebuyer Education Course

Information for Government Monitoring Purposes Only!