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Primary Applicant First name
Primary Applicant Last name
Email address
Username
Password
Street (Primary applicant)
House number (Primary applicant)
City (Primary applicant)
State (Primary applicant)
Zipcode (Primary applicant)
Phone number (where to reach) (Primary applicant)
Second applicant First and Last name
Date of Birth
Age Range
Select an option...
Below 25
26-35
36-45
46-55
Above 55
U.S. Citizen
Select an option...
Yes
No
Choose not to disclose
Gender
Select an option...
Non-Gender Confirming
Male
Female
Other
Choose not to disclose
Ethnicity
Select an option...
Hispanic
Not Hispanic
Choose not to disclose
Are you a First Time Homebuyer?
Select an option...
Yes
No
Are you proficient in speaking English?
Select an option...
Yes
No
Race
Select an option...
American Indian or Alaskan Native
American Indian or Alaskan Native and Black or African American
American Indian or Alaskan Native and White
Asian
Asian and White
Black or African American
Black or African-American and White
Native Hawaiian or Other Pacific Islander
Chose not to respond
Other
Other Multiple Race
White
Marital Status
Select an option...
Chose not to respond
Divorced
Married
Separated
Single
Unknown
Unmarried
Widowed
Household type
Select an option...
Female-headed single parent household
Married without dependents
Married with dependents
Male-headed single parent household
Two or more unrelated adults
Other
Single adult
Current Household Type
Select an option...
Association Board Member
Homeless
Living with Family
Living with Friends
Living with Parents
Other
Own
Owner Non-Board Member
Rent
Shelter/Homeless
# in household
Select an option...
1
2
3
4
5
6
7
8
9
10
# of Dependents in Household
Select an option...
0
1
2
3
4
5
6
7
8
9
10
Do you have a household member with a disability?
Select an option...
Myself
Other family member in household
None
Choose not to disclose
Highest level of education
Select an option...
Bachelor’s degree or higher
Chose not to respond
Some college or Associate
Some college-Never completed
Doctoral degree
Elementary
GED® diploma
Graduate School
High School
High School Diploma or equivalent
Junior College
Junior High
Less than High School Diploma
Other
University
Unknown
What is your last known credit score
Total Annual Family Income $
How much have you saved toward your upcoming home purchase? $
Are you a veteran?
Select an option...
Active Duty Personnel
Duty 1-4 Years
Duty 5-8 Years
N/A
National Guard Personnel
Veteran
Unknown
Are you Active Military?
Select an option...
Yes
No
Have you already selected the home that you are purchasing?
Select an option...
Yes
No
Have you met with a lender about getting a home loan?
Select an option...
Yes
No
I agree to release the Closing Disclosure settlement statement and other info
I grant permission for Homebuyer representatives to discuss my loan application
What is your Loan Number?
How did you hear about HomeTRACK?
Select an option...
Advertisement
Housing Counseling Agency
Lender
Real Estate Agent
Website: Word of Mouth
Other
Zillow
DownPaymentResource.com
Social media
HomeTRACK Social Media Campaign
HEAUSA Road Show
Enthousiastic Participant in the program
I am taking this course to:
Meet my lender's qualifications
Become more educated about the home buying process
Determine if owning a home is the right decision
Learn how much I can spend on purchasing a home
Other
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