Cabarrus & Rowan Financial Empowerment Forum Survey

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* 1. Participant Information - Please include First and Last name

Name

Address

City/Town

State

ZIP/Postal Code

Email Address

Phone Number

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* 2. Co-participant Information - Please provide First and Last Name

Name

Address

City/Town

State

ZIP/Postal Code

Email Address

Phone Number

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* 3. Which location will you be attending?

Clearwater Art Center in Concord - 223 Crowell Drive NW, Concord, NC 28025

Miller Teen Recreation Center in Salisbury - 1402 West Bank Street, Salisbury, NC 28144

Hybrid Option - Please send Zoom Link (make sure we have correct email address as Zoom link will be emailed to you)

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* 4. Are you interested in home purchase?

Yes

No, already own.

Any comments on housing need.

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* 5. Are you currently working with a realtor?

Yes

Name and contact information:

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* 6. Are you currently working with a lender (if purchasing) or servicer (if needing help for foreclosure prevention)?

Yes

Name and contact information:

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* 7. Marital Status:

	Married	Divorced	Separated	Never Been Married	Widowed	Domestic Partner
Participant	Participant Married	Participant Divorced	Participant Separated	Participant Never Been Married	Participant Widowed	Participant Domestic Partner

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* 8. Marital Status:

	Married	Divorced	Separated	Never Been Married	Widowed	Domestic Partner
Co-Participant	Co-Participant Married	Co-Participant Divorced	Co-Participant Separated	Co-Participant Never Been Married	Co-Participant Widowed	Co-Participant Domestic Partner

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* 9. Do you need to schedule a one-on-one counseling session? Please Read This Carefully - NOTE: This is a requirement if you would like to be assess for down payment assistance funds, WeBuild's homes, need help in finding the right lending institution or need help to save a home.

The counseling will also assess your mortgage and homeownership-readiness and give you guidance on how to get to "Yes" from a lender/servicer.

Yes

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* 10. Number of people in your household:

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* 11. Date of Birth - Participant

Enter your birthdate:

Date

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* 12. Date of Birth - Co-participant

Enter your birthdate:

Date

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* 13. Which race/ethnicity best describes you? (Please choose only one.)

	American Indian or Alaskan Native	Asian/Pacific Islander	Black or African American	Hispanic	White/Caucasian	Choose Not to Respond
Participant	Participant American Indian or Alaskan Native	Participant Asian/Pacific Islander	Participant Black or African American	Participant Hispanic	Participant White/Caucasian	Participant Choose Not to Respond
Co-Participant	Co-Participant American Indian or Alaskan Native	Co-Participant Asian/Pacific Islander	Co-Participant Black or African American	Co-Participant Hispanic	Co-Participant White/Caucasian	Co-Participant Choose Not to Respond

Multiple ethnicity / Other (please specify)

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* 14. What is your citizenship status? (Please choose only one.)

	US Citizens	DACA	Permanent Resident Alien
Participant	Participant US Citizens	Participant DACA	Participant Permanent Resident Alien
Co-Participant	Co-Participant US Citizens	Co-Participant DACA	Co-Participant Permanent Resident Alien

Other (please specify)

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* 15. Rural Area Status:

	Household lives in a rural area	Household does not live in a rural area
Participant	Participant Household lives in a rural area	Participant Household does not live in a rural area
Co-Participant	Co-Participant Household lives in a rural area	Co-Participant Household does not live in a rural area

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* 16. Ethnicity Type:

	Hispanic/Latino	Not Hispanic/Latino	Choose Not to Answer
Participant	Participant Hispanic/Latino	Participant Not Hispanic/Latino	Participant Choose Not to Answer
Co-Participant	Co-Participant Hispanic/Latino	Co-Participant Not Hispanic/Latino	Co-Participant Choose Not to Answer

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* 17. Limited English Proficiency Status:

	Household is Limited English Proficiency	Household is not Limited English Proficiency
Participant	Participant Household is Limited English Proficiency	Participant Household is not Limited English Proficiency
Co-Participant	Co-Participant Household is Limited English Proficiency	Co-Participant Household is not Limited English Proficiency

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* 18. Preferred Language

	English	Spanish
Participant	Participant English	Participant Spanish
Co-Participant	Co-Participant English	Co-Participant Spanish

Other (please specify)

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* 19. Employment Information - Participant

Name of Employer:

Yearly Income:

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* 20. Employment Information - Co-Participant

Name of Employer:

Yearly Income:

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* 21. Acknowledgement: I am aware that this is an introduction to the homebuying, credit awareness and foreclosure prevention processes only.

	Agree
Participant	Participant Agree	Participant
Co-Participant	Co-Participant Agree	Co-Participant

Other (please specify)

Cabarrus & Rowan Financial Empowerment Forum

Section 1: Registration

Question Title

* 1. Participant Information - Please include First and Last name

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* 2. Co-participant Information - Please provide First and Last Name

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* 3. Which location will you be attending?

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* 4. Are you interested in home purchase?

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* 5. Are you currently working with a realtor?

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* 6. Are you currently working with a lender (if purchasing) or servicer (if needing help for foreclosure prevention)?

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* 7. Marital Status:

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* 8. Marital Status:

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* 10. Number of people in your household:

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* 11. Date of Birth - Participant

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* 12. Date of Birth - Co-participant

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* 13. Which race/ethnicity best describes you? (Please choose only one.)

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* 14. What is your citizenship status? (Please choose only one.)

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* 15. Rural Area Status:

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* 16. Ethnicity Type:

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* 17. Limited English Proficiency Status:

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* 18. Preferred Language

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* 19. Employment Information - Participant

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* 20. Employment Information - Co-Participant

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* 21. Acknowledgement: I am aware that this is an introduction to the homebuying, credit awareness and foreclosure prevention processes only.