HOME STRETCH WORKSHOP REGISTRATION

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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: ___________________________________

Email: _________________________________________

Home Buyer (only) please continue:

1. How did you hear about this workshop?

Co-Buyer Attending workshop? Yes No

Name: ________________________________________

(Please print) First MI Last

Address: _______________________________________

City: ____________________________ State: _________

Zip: __________ County: __________________________

Home Phone: ___________________________________

Email: _________________________________________

Relationship to Buyer: ____________________________

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

H OME S TRETCH W ORKSHOP R EGISTRATION

Organization: ____________________________________________________________

Workshop location: ________________________ Workshop Date(s): _______________

CAPSH Home Stretch Workshop Registration form 2011-2012 (11/11) Page 1

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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): _______________________________

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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 Signature Date Co-Buyer Signature Date

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H

OUSING AND

R

ELATED

P

ROGRAMS

:

D

ISCLOSURE

S

TATEMENT

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.

Signature Date

If signing as a representative for a client, please indicate relationship:

CAPSH HUD Conflict Form (rev. 09/12)

COMMUNITY ACTION PARTNERSHIP OF

SUBURBAN HENNEPIN

8800 Highway 7, Suite #401 St. Louis Park, MN 55426 952-933-9639 www.capsh.org

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H

OUSING AND

R

ELATED

P

ROGRAMS

:

D

ISCLOSURE

S

TATEMENT

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.

Signature Date

If signing as a representative for a client, please indicate relationship:

CAPSH HUD Conflict Form (rev. 09/12)

COMMUNITY ACTION PARTNERSHIP OF

SUBURBAN HENNEPIN

8800 Highway 7, Suite #401 St. Louis Park, MN 55426 952-933-9639 www.capsh.org

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