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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
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Yes
No
Choose not to disclose
Gender
Select an option...
Male
Female
Choose not to disclose
Ethnicity
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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
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White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
More than one race
Choose not to respond
Marital Status
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Single
Married
Divorced
Seperated
Widowed
Domestic partner
Household type
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Female headed single parent household
Male headed single parent household
Single Adult
Two or more unrelated Adults
Married with children
mariied without children
Other
Current Household Type
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Public housing
Rent
Own
Living with friends or family
# in household
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1
2
3
4
5
6
7
8
9
10
# of Dependents in Household
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1
2
3
4
5
6
7
8
9
10
Do you have a household member with a disability?
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Myself
Other family member in household
None
Choose not to disclose
Highest level of education
Select an option...
Below High school diploma
High school diploma
Two years college degree
Bachelors degree
Masters degree
Above Masters degree
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...
Yes
No
Are you Active Military?
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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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