Universal Application

Renter's Readiness Class Registration

Associated Ministries
First Name*
M.I.
Last Name*
Email*
example@example.com
Type of device being used to join online class*
Who referred you to Renter's Readiness Classes? (enter agency and/or staff name)*
If found through internet search, enter "Online Search."
Household Information:
Household Size*
Number Adults*
Number Children*
Total Household Monthly Income*
Source of Income (Select all that apply to Total Monthly Income above)*

WagesSelf-EmploymentUnemployment/ Labor & IndustriesRetirement/PensionSSI/SSDIDSHS TANF/ABDSNAP Food BenefitsChild Support/AlimonyNoneOther
Housing Status

Please provide the following information about your current living situation.
Housing Status*
Housing/Shelter Type*
Start Date

MonthDayYear
*If unsure, enter estimated date (to the best of your memory)
How Long
*If unsure, enter estimated length of time (to the best of your memory)
Address

***If homeless, please enter the City and Zip Code where you stay most often. If Zip Code is unknown enter "Unknown"
House/Street Address
*Leave blank if not applicable
Apt/Unit
City*
Zip Code*
Demographic Information

Please complete the demographic information below.
DOB*

MonthDayYear
Age
Gender*
Other Gender
Pronouns
Other Pronouns
Sexual Orientation*
Other Sexual Orientation
Primary Race*
Multi-racial*
Secondary Race
Ethnicity*
Disability*
Health Insurance*
Primary Language*
Other Primary Language
Marital Status*
Employment*
Veteran Status*
Last Grade of School Completed*
Should be Empty:

Renter's Readiness Class Registration