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Post Purchase Event Registration
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1.
Privacy and Disclosure Statement
CCCS of Rochester is a not- for-profit credit counseling agency. We are a HUD approved housing counseling agency offering counseling services that include First Time Homebuyer Counseling and Education, Reverse Mortgage Counseling and Foreclosure Prevention. We also offer Credit and Debt Counseling, Debt Management Programs and Bankruptcy Counseling; however, you are under no obligation to purchase or use any of these other services. CCCS may receive funding from various nonprofit organizations, private grants, and government sources. As such, CCCS may be required to share some of your personal information with program administrators or their agents for monitoring and compliance.
CCCS may also use your demographic information to for marketing purposes, however we will not disclose your information unless required to do so by law. To protect your information for unauthorized access, we use security measures that comply with Federal and State law. You acknowledge that this session may be recorded and/or monitored for quality assurance.
By entering yes below, I agree that I have reviewed and understand the above Privacy & Disclosure Statement. Furthermore, I give consent to CCCS of Rochester to use and/or share some or all of my information with program administrators or their agents for monitoring and compliance.
By entering no, I do not give consent to CCCS of Rochester to use and/or share some or all of my information with program administrators or their agents for monitoring and compliance. Please keep in mind by entering, no we cannot move forward with collecting your demographic information.
Do you agree and sign to the above disclosure?
(Required.)
Yes
Thank you for your interest in attending Post Purchase Workshop. Please fill out this survey to get registered.
2.
Your contact info:
First Name
Last Name
New Address
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
3.
Date of closing
4.
Date of Birth
5.
Highest level of education completed
High School
College
Graduate School
Elementary School
Other
6.
What is your marital status?
Single
Married
Divorced
Domestic Partnership
Other
7.
Are you a veteran?
Yes
No
8.
What lender did you work with?
9.
What is your race or ethnicity?
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Multiracial or Multiethnic
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White
Another race or ethnicity, please describe below
Self-describe below:
10.
Do you live in a rural area?
Yes
No
11.
Does your household have limited English proficiency?
Yes
No
12.
Please name the grant program or programs you worked with
13.
Do you give CCCS permission to send a copy of your Post Purchase Certificate to City of Rochester Homebuyer Assistance program coordinators?
Yes
No
*
14.
What is your approximate household income?
(Required.)
*
15.
How many dependents live in your household?
(Required.)
16.
Which date will you be attending? Each workshop is offered from 6-7:30 PM
6/8/2021
7/13/2021
8/10/2021
