Homebuyer Education Workshop Registration

** Please that ALL MS workshops are In-Person, and will be held at

521 Marion Ave., McComb, MS 39648 **

PROVIDE AN ACCURATE EMAIL ADDRESS TO ENSURE YOU ARE PROPERLY REGISTERED FOR THE IN-PERSON WORKSHOPS.

9 am- 3 pm (CST)

- Intake packets will be sent via Adobe and are required as part of the registration process.

- Once your registration has been received, you will receive an email confirming your attendance -

Workshops are offered (In- Person) on the 2nd Saturday of each month. Choose the date that best fits your schedule.

Please choose a day below to attend:

Participant Information (if you have a Co-Borrower, he/ she must register separately)

Are you a previous D&E client?

Yes

No

Include my contact information on lists distributed to other attendees.

Yes

No

First Name *

Last Name *

Address 1 *

City *

State *

Postal Code *

County *

Phone *

Email Address *

Birthdate *

Number in household *

Gross Monthly Income *

Household Annual Income *

Do you have a Co-Applicant? Y/N *

Yes

No

Co-Applicant Full Name *

Co-Applicant email address *

Current Housing Arrangement *

Rent

Not Paying Rent

Homeowner With Mortgage

Homeowner Without Mortgage

Rural Area Status. *

Lives in a Rural Area

Does not Live in a Rural Area

Chose Not to Respond

Race *

Gender *

Male

Female

Marital status *

Head of household? *

Yes

No

English Level *

Limited English Proficient

Not Limited English Proficient

Chose Not to Respond

Are you Hispanic? *

Yes

No

Veteran? *

Yes

No

Active Military? *

Yes

No

Disability? *

Yes

No

1st Time Homebuyer? *

Yes

No

1st Generation Homebuyer? *

Yes

No

Foreign born? *

Yes

No

Household type? *

Highest level of education *

Lender Information

Are you currently working with a lender? Y/N *

Yes

No

If yes, please provide the Lender's contact information below:

Name

Company

Phone Number

Email

Do you have a tentative Closing Date scheduled? Y/N *

Yes

No

If yes, please provide the Closing Date information below:

Closing Date?

Interested in Receiving Additional No-Cost Services?

Please indicate below any additional services that you may interested in, by checking the boxes below. *

What are your biggest challenges?

What are your biggest Challenges or What would you like to learn more about? *

Select all that apply *

How did you hear about this workshop?

Select an option below: *

D&E's Privacy Policy

D&E, A Housing & Economic Empowerment Center, Inc. is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all personal information shared orally and/or in writing will be managed within ethical and legal considerations. Your “nonpublic personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your authorization. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs. What personal information does D&E collect about you? We collect personal information about you from the following sources: • Information that you provide on applications, forms, email, or verbally • Information about your transactions with us, our affiliates, or others • Information we receive from your creditors or employment references • Information we receive from a credit reporting agency, such as your credit history. What categories of information do we disclose and to whom? We may disclose the following personal information to financial service providers (such as companies providing home mortgages), Federal, State, and nonprofit partners for program review, monitoring, auditing, research, and/or oversight purposes, and/or any other pre-authorize individual and/or organization. The types of information we disclose are as follows: • Information you provide on applications/forms or other forms of communication. This information may include your name, address, Social Security Number, employer, occupation, account numbers, assets, expenses and income. • Information about your transactions with us, our affiliates, or others; such as your account balance, monthly payment, payment history, and method of payment. • Information we receive from a consumer credit reporting agency; such as your credit bureau; we do not sell or rent your personal information to any outside entity. • We may share anonymous, aggregated case file information; but this information may not disclose in any manner that would personally identify you in any way. This is done in order to evaluate our program, gather valuable research information, and/or design future programs. • We may also disclose personal information about you to third parties as permitted by law. How is your personal information secured? We restrict access to your nonpublic personal information to D&E employees who need to know that information in order to perform their housing counseling duties. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information; and we train our staff to safeguard client information and prevent unauthorized access, disclosure, or use. Opting Out of Certain Disclosures You may direct D&E to not disclose your nonpublic personal information to third parties (other than disclosures made to protect partners and those permitted by law). However, if you choose to opt out, we will not be able to answer any questions from your creditors, which may limit D&E’s ability to provide services such as foreclosure prevention counseling or credit restoration counseling. If you choose to opt-out, please check the box next to the “Opt-Out” clause. If you choose to release your information as stipulated in Privacy Policy, check the box next to the “Release” clause. You may change your decision at any time by contacting our agency. RELEASE: I hereby authorize D&E to release nonpublic personal information it obtains about me to my creditors and any third parties necessary to provide me with the services I requested. I acknowledge that I have read and understand the above privacy practices and disclosures. I acknowledge that I have received a copy of the Privacy Policy. OPT-OUT: I request that D&E make no disclosures of my nonpublic personal information to third parties other than project partners and those permitted by law. By choosing this option, I understand that D&E will NOT be able to answer any questions from my creditors. I understand that I may change my decision any time by contacting D&E. I acknowledge that I have received a copy of the Privacy Policy. *

Release

Opt Out

I understand and agree that this is a virtual workshop of 5 hours and that in order to satisfy the 6-8 hour HUD requirement to obtain my Certificate of Completion, I must complete the 1-on-1 pre-purchase/rental counseling. *

All the information that I provided in this worksheet is correct and factual. No information has been withheld. I understand the understand the necessity for accurate and complete information in obtaining a favorable resolution. I/We will provide any needed information to assist the Housing Counselor. I understand that deliberately providing inaccurate information or an unwillingness to timely provide the Counselor with the necessary information or documents to assist us can result in an adverse outcome. It will also result in closing our file and no further assistance from the Counselor will be provided. * 🛈

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** ALL MS WORKSHOPS ARE IN-PERSON **

PROVIDE AN ACCURATE EMAIL ADDRESS TO ENSURE YOU ARE PROPERLY REGISTERED FOR THE WORKSHOPS.