Client Application- Workshops
Tenant Services, a Division of Family Housing Advisory Services, Inc.
Please complete the entire application
Today's Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Please Select Workshop
Housing Matters
RentWise
Why are you interested in taking this class?
Full Name:
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 000-000-0000.
Email Address:
example@example.com
Current Address:
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County
Current Living Situation
Number of bedrooms
Gender:
*
Female
Male
Non- Binary
Prefer not to specify
Date of Birth:
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age range
*
18 to 24 Years
25 to 44 Years
45 to 64 Years
65 Years and Above
Ethnicity:
*
Hispanic
Non- Hispanic
Citizenship:
*
U.S Citizen
Permanent Resident
Not U.S. Citizen/Permanent Resident
Primary Language:
*
Please select all that apply:
*
Disabled
Veteran
Limited English Profiency
None of the above
Discharge Type:
Honorable
General Discharge - Under Honorable Conditions
OTH (Other Than Honorable)
Dishonorable Discharge
Entry- level Separation
Medical 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 Name
Last Name
Emergency Contact Phone Number:
Please enter a valid phone number.
Format: 000-000-0000.
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?
Save
Submit
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