First Name *

Last Name *

Email *

Street Address

City

Phone Number

Will there be a Co-Applicant? Note: A Co-Applicant is another person you would purchase a home with. YesNo

Are all members of your household permanent residents or US Citizens? YesNo

Have you lived or worked in Outagamie, Calumet, Waupaca or northern Winnebago County for at least 6 months? YesNo

Including yourself, how many people live in your household?

What is the gross annual income (before taxes and deductions) for your household?

Do you or the co-applicant have any debt in collections, or any unsatisfied liens or judgments? YesNo

Have you or the co-applicant filed for bankruptcy? YesNo

The following questions are optional and are collected for reporting and equity purposes only. They will not affect your eligibility. Do you speak English? YesNo

What is your primary language?

Race/Ethnicity (select all that apply) American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoMiddle Eastern or North AfricanNative Hawaiian or Pacific IslanderWhitePrefer not to answer

Prefer to Self-Describe

Gender MaleFemaleOtherPrefer not to answer

Immigration Background: I was born in the United StatesI moved to the U.S. from another countryPrefer not to answer

Please share your country of origin

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