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English (US)
Spanish (Latin America)
"Camino a Casa" Class Registration Form
Your answers to the following questions help us understand individual and community trends so that we may do our best work. When requested, demographic information will be shared with funders who support Hacienda CDC and would like to know who is impacted by our programs. This information is secure, confidential, and never shared individually. If you feel comfortable disclosing this information, please continue. At the end of this form you will be redirected to sign-up for one of our Camino a Casa orientations.
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First Name
*
Middle Name
Last Name
*
Household Contact Information
Address
*
Street Address
Street Address Line 2
City
Please Select
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State
Zip Code
State
*
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OR
PA
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VA
WA
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WI
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County
*
County
*
Please Select
Baker County
Benton County
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Tillamook County
Umatilla County
Union County
Wallowa County
Wasco County
Washington County
Wheeler County
Yamhill County
County
*
Please Select
Adams County
Asotin County
Benton County
Chelan County
Clallam County
Clark County
Columbia County
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Douglas County
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Grant County
Grays Harbor County
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King County
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Kittitas County
Klickitat County
Lewis County
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Mason County
Okanogan County
Pacific County
Pend Orielle County
Pierce County
San Juan County
Skagit County
Skamania County
Snohomish County
Spokane County
Stevens County
Thurston Count
Wahkiakum County
Walla Walla County
Whatcom County
Whitman County
Yakima County
Do you live in a rural area?
*
Yes
No
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
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Basic Demographic Information
Birthdate
*
/
Month
/
Day
Year
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Gender (choose all that apply)
*
Woman or Girl
Man or Boy
Transgender
Non-binary
Two-Spirit
Don't know
Don't want to answer
Not listed
If gender not listed, please list here:
Racial or Ethnic Identity (choose all that apply)
*
Hispanic or Latino/a/x/e
Native Hawaiian or Pacific Islander
White
Indigenous, American Indian, or Alaska Native
Black or African American
Middle Eastern or North African
Asian
Biracial or Multiracial
Don't know
Don't want to answer
Not listed
If identity not listed, please list here:
What is your highest level of education?
*
Elementary
High School
Vocational
University
None
Not listed
If highest level of education not listed, please list here:
Please share any additional identities
Person with a disability
Immigrant
Refugee
Veteran
Farmworker
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Household Information
What language(s) do you use at home?
*
English
Spanish
Vietnamese
Russian
Chinese
Somali
Maay Maay
Maya
Swahili
Don't know
Don't want to answer
Not listed
If language not listed, please list here:
How well do you speak English?
*
Very well
Well
Not Well
Not at all
Annual Household Income
*
Please estimate the total amount of income your family makes in a year
Household Size
*
Please put how many people live in your household
Number of dependents (children under 18)
*
Are you a first-time homebuyer?
*
Yes
No
Do your parents/guardians currently own a home or have they ever owned a home?
*
Yes
No
How did you hear about us?
Internet
Word of mouth
Outreach Event
Community Organization
Government Agency
Brochure
Lender
Realtor
TV
Radio
Newspaper
Schools
Other
I would like to stay up to date with Hacienda CDC and receive email communications.
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Thank you for your responses!
After submitting this form you will be redirected to the sign-up page for our Camino a Casa orientations, where you can learn more about the homebuying process and Hacienda CDC's homeownership services. You may sign up at this time or at a later date with a link sent to your email.
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