Post Purchase Event Registration Question Title * 1. Privacy and Disclosure StatementCCCS 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? Yes Thank you for your interest in attending Post Purchase Workshop. Please fill out this survey to get registered. Question Title * 2. Your contact info: First Name Last Name New Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. Date of closing Question Title * 4. Date of Birth Question Title * 5. Highest level of education completed High School College Graduate School Elementary School Other Question Title * 6. What is your marital status? Single Married Divorced Domestic Partnership Other Question Title * 7. Are you a veteran? Yes No Question Title * 8. What lender did you work with? Question Title * 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: Question Title * 10. Do you live in a rural area? Yes No Question Title * 11. Does your household have limited English proficiency? Yes No Question Title * 12. Please name the grant program or programs you worked with Question Title * 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 Question Title * 14. What is your approximate household income? Question Title * 15. How many dependents live in your household? Question Title * 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 Done
