HOME STRETCH WORKSHOP REGISTRATION

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1 HOME STRETCH WORKSHOP REGISTRATION Organization: Workshop location: Workshop (s): Instructions: Please fill out as completely as possible. If you need additional space, please feel free to use the back side or make additional copies as necessary. Home Buyer Name: (Please print) First MI Last Address: City: State: Zip: County: Home Phone: Work Phone: Co-Buyer Attending workshop? Yes No Name: (Please print) First MI Last Address: City: State: Zip: County: Home Phone: Relationship to Buyer: Home Buyer (only) please continue: 1. How did you hear about this workshop? Mailer, Flyer, or Brochure Newspaper ad Agency (which one: ) Friend or Relative Internet Realtor Someone who took a workshop Lender / Mortgage company other: 2. Your ethnicity: Hispanic, Latino, or Spanish Non-Hispanic 3. Race: (Select one) American Indian / Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other race: American Indian / Alaskan Native & White American Indian / Alaskan Native & Black Asian & White Black or African American & White Native Hawaiian/Other Pacific Islander & Black 4. How many people will live in the house? 5. Your gender: Male Female CAPSH Home Stretch Workshop Registration form (11/11) Page 1

2 Information about home buyer (Continued): 6. Your age: 7. Are you disabled? Yes No 8. Are you a single parent household? Yes No 9. Please check the highest education level you completed: Some High School Some college or trade school Bachelors degree High School / GED Associates / 2 year degree Graduate or professional degree 10. Marital Status: Single Married Divorced Widow 11. Household Income: Please include income for all individuals from all sources (work, disability, child support, etc.) Name (person receiving income) Source of Income Net Monthly Amount (after taxes) 12. Current housing: Rent Own Staying with family / friends 13. Are you a first time home buyer? Yes No (You have not owned a home for the past three years.) 14. Are you a first generation home buyer? Yes No (Your parents did not own a home.) 15. How many dependent children will live in the house? 16. Current household rent / month 17. Have you applied for a mortgage loan or signed a purchase agreement? Yes No 18. Have you experienced a home foreclosure within the past 3 years? Yes No If you answered yes to question 17, please complete the purchase property information for your new home: Purchase property address: City: State: Zip: Purchase price: Loan amount: Loan interest rate: % Closing date: Lender (Bank/Mortgage Co.): Loan program (FHA, RD, etc): CAPSH Home Stretch Workshop Registration form (11/11) Page 2

3 Disclosure Statement While you may learn about the advantages/disadvantages of specific loan products during the Home Stretch workshop, you are free to choose lenders, loan products and homes of your own choosing regardless of the recommendations made by educators. By signing below, you acknowledge that you have received and read this disclosure notice. Applicant Certification I certify that the statements contained in this application are true, accurate, and complete to the best of my/our knowledge and belief. I/We herby authorize the release of any information necessary for this organization to process this application. Homebuyer Co-Buyer CAPSH Home Stretch Workshop Registration form (11/11) Page 3

4 COMMUNITY ACTION PARTNERSHIP OF SUBURBAN HENNEPIN 8800 Highway 7, Suite #401 St. Louis Park, MN HOUSING AND RELATED PROGRAMS: DISCLOSURE STATEMENT Community Action Partnership of Suburban Hennepin (CAPSH) is approved by the US Department of Housing and Urban Development (HUD) and the Minnesota Housing Finance Agency to provide housing counseling services. You may be receiving services or information about First Time Home Buyer, Refinancing, Reverse Mortgage (HECM), Foreclosure Prevention, Home Rehab and Maintenance, Transitional Housing/Homelessness, Asset Development and/or Budgeting. Your services may be through one-on-one counseling or a workshop. All CAPSH services are provided in accordance with state and federal law. During workshops, speakers and material may be presented from the private sector. This information is provided in a neutral manner, to inform participants of the types of services available. This is in no way intended to be an endorsement or recommendation of any specific company, agency, product or service. In providing all of its services, CAPSH is acting as a neutral third party. Additionally, during counseling, participants may receive lists of potential vendors, brokers, mortgage companies, banks and similar services. This is for informational purposes only, and is in no way intended to be an endorsement or recommendation of any specific company, agency, product or service. You, the participant/client, are free to choose any lender, loan product, home, provider or service that you want. While affordable homes, lending products and other forms of assistance may be available through CAPSH and/or its partners, you are under NO obligation to use these services. Decisions to use any provider, lender or other related service or program, is your decision alone, and CAPSH will not try to influence your decision in any way. Please sign below to indicate that you have read the above information, understand it and have received a copy of this Statement. If signing as a representative for a client, please indicate relationship: CAPSH HUD Conflict Form (rev. 09/12)

5 COMMUNITY ACTION PARTNERSHIP OF SUBURBAN HENNEPIN 8800 Highway 7, Suite #401 St. Louis Park, MN HOUSING AND RELATED PROGRAMS: DISCLOSURE STATEMENT Community Action Partnership of Suburban Hennepin (CAPSH) is approved by the US Department of Housing and Urban Development (HUD) and the Minnesota Housing Finance Agency to provide housing counseling services. You may be receiving services or information about First Time Home Buyer, Refinancing, Reverse Mortgage (HECM), Foreclosure Prevention, Home Rehab and Maintenance, Transitional Housing/Homelessness, Asset Development and/or Budgeting. Your services may be through one-on-one counseling or a workshop. All CAPSH services are provided in accordance with state and federal law. During workshops, speakers and material may be presented from the private sector. This information is provided in a neutral manner, to inform participants of the types of services available. This is in no way intended to be an endorsement or recommendation of any specific company, agency, product or service. In providing all of its services, CAPSH is acting as a neutral third party. Additionally, during counseling, participants may receive lists of potential vendors, brokers, mortgage companies, banks and similar services. This is for informational purposes only, and is in no way intended to be an endorsement or recommendation of any specific company, agency, product or service. You, the participant/client, are free to choose any lender, loan product, home, provider or service that you want. While affordable homes, lending products and other forms of assistance may be available through CAPSH and/or its partners, you are under NO obligation to use these services. Decisions to use any provider, lender or other related service or program, is your decision alone, and CAPSH will not try to influence your decision in any way. Please sign below to indicate that you have read the above information, understand it and have received a copy of this Statement. If signing as a representative for a client, please indicate relationship: CAPSH HUD Conflict Form (rev. 09/12)

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