Landlord 101 - Part 3

1
Name / Nombre
First Name
Last Name
2
Email / Correo electrónico
example@example.com
3
Address / Dirección
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Phone Number / Número de teléfono
Please enter a valid phone number.
5
Year of birth / Año de nacimiento
6
Are you disabled? / ¿Eres discapacitado??
Please Select
Please Select
Yes / Si
No
7
Are you a U.S. Veteran? / ¿Es usted un veterano de los Estados Unidos?
Please Select
Please Select
Yes / Si
No
8
Head of Household / Jefe de familia
Male Head of Household
Female Head of Household
Non-Binary Head of Household
Other
9
Race /
American Indian/Alaskan Native
Asian
Black or African American
White
Native Hawaiian or Other Pacific Islander
More than one race/Other race not listed
Chose not to respond/Data not collected
10
Yearly Income / Ingreso anual
Hispanic
Non-Hispanic
Data Not Collected
11
Consent & Media Release:Consent & Media Release: I understand this workshop is for educational purposes only and does not constitute legal advice. I also consent to the use of photos, video, or other media taken during the workshop for outreach and educational purposes. Consentimiento y Autorización de Medios: Entiendo que este taller es únicamente con fines educativos y no constituye asesoría legal. También doy mi consentimiento para el uso de fotografías, videos u otros medios tomados durante el taller para fines educativos y de divulgación.
YESNO
12
SignatureThank you for participating in a workshop with Northwest Side CDC where our mission is to provide the Northwest Side and Belmont Cragin with the tools and resources to preserve affordable housing and prevent displacement and provide business development assistance to local small businesses. We ask all visitors to fill out an intake that is used solely for our internal reporting purposes. // Gracias por participar en un taller con Northwest Side CDC, donde nuestra misión es proporcionar a Northwest Side y Belmont Cragin las herramientas y recursos para preservar la vivienda asequible y prevenir el desplazamiento, así como brindar asistencia en el desarrollo empresarial a los pequeños negocios locales. Pedimos a todos los visitantes que completen un formulario de registro que se utiliza únicamente con fines de informes internos.
Should be Empty: