Client Application

Client Application- Workshops

Tenant Services, a Division of Family Housing Advisory Services, Inc.
Please complete the entire application
Today's Date*

MonthDayYear
Please Select Workshop

Housing MattersRentWise
Why are you interested in taking this class?
Full Name:*

First NameMiddle NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address:
example@example.com
Current Address:

Street Address

Street Address Line 2

CityState

Zip Code
County
Current Living Situation
Number of bedrooms
Gender:*

FemaleMaleNon- BinaryPrefer not to specify
Date of Birth:*

MonthDayYear
Date
Age range*

18 to 24 Years25 to 44 Years45 to 64 Years65 Years and Above
Ethnicity:*

HispanicNon- Hispanic
Citizenship:*

U.S CitizenPermanent ResidentNot U.S. Citizen/Permanent Resident
Primary Language:*
Please select all that apply:*

DisabledVeteranLimited English ProfiencyNone of the above
Discharge Type:

HonorableGeneral Discharge - Under Honorable ConditionsOTH (Other Than Honorable)Dishonorable DischargeEntry- level SeparationMedical Separtaion
Highest Level of Education
Marital Status
Total Number of people in the Household?*
Number of Adults in the home?*
Number of Children in the home?*
If NO children reside in home enter zero.
Net Income : After- Tax Income:*

Under $15,000$15,000 to $24,999$25,000 to $34,999$35,000 to $49,999$50,000 to $74,999$75,000 and Above
Emergency Contact:

First NameLast Name
Emergency Contact Phone Number:
Please enter a valid phone number.
Relationship to you:
Ex: Mother, Father, Friend, Aunt. If you do not have an emergency contact please leave blank.
At the end of the workshop would you like to scedule a one on one with a Housing Client Advocate?
Should be Empty:

Client Application- Workshops