“Thank you for your interest in IMPACCT Brooklyn’s First Time Home Buyer Program.
After completing this form, you will receive a link to register for the next workshop
5-10 business days before the scheduled session
.
Please note that the Zoom registration is unique to you and
cannot be transferred or shared
with others.
First Name
Last Name
Email
Date of Birth
If you own or are looking to purchase a home with a co-applicant please fill out his/her information. If not leave it blank.
Co-Applicant First Name
Co-Applicant Last Name
Co-Applicant's DOB
Co-Applicant's Gender
Male
Female
Non-Conforming
Gender
Male
Female
Non-Conforming
Marital Status
Married
Single
Separated
Divorced
Widowed
Domestic Partnership
Rather Not Say
Annual Household Income
Street Address
City
State
ZIP
Contact Number
How Many People live in your household?
Your Highest Level of Education
None
Primary
Vocational
High School/GED
College
Bachelor's Degree
Trade School
Other
Rural Status
I live in a rural area
I do not live in a rural area
I choose not to respond
English Proficiency
Yes, I'm fluent in English
No, I'm not good with English
Are you a veteran?
Yes
No
Are you currently in the military?
Yes
No
Your Race?
African American
White Non-Hispanic
Hispanic
American Indian/ Alaskan Native
Hawaiian/Pacific Islander
Other Multiple Race/ Non-Hispanic
Choose not to respond
How did you hear about us? (check all that apply)
Agency
Email
Social Media
Realtor
Workshop
Friend/Relative
Lender
Mailer
Seminar
HUD
Walk-In
Word of Mouth
Other
On what date would you like to attend the workshop?
May 10th & 17th
June 21st & 28th
I can't attend either of these dates, but please update me on upcoming workshops.
These programs are funded by Federal and State agencies, Private Funders and Individual Donors. We are required to collect demographic information in order to process your pre-registration. Information will be used solely to evaluate programs and the people to whom the program is serving. Personal information will never be shared and will be treated with strict confidentiality.
I accept
I do not accept
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