Housing Counseling Services, Inc. Webinar Registration Form

We are no longer using this webinar registration form. You can go here to register for our classes!

Unfortunately there are no classes available for this program at this time, please call us at 202-667-7606 to let us know that you are seeing this message.

Webinar Information

You may only register for one course at a time. If we are offering more than one course below, you may only register for one of them.

Would you like to take this workshop on-line or in-person?

Name of Session

Date/Time Session Offered

Would you like to attend this session?

Yes

Applicant Information

Primary Applicant

First Name:

Last Name:

Gender:

Date of Birth:

Example: 01/01/1990. You must be at least 18 years old to register for a course.

Email:

Phone:

Race:

Ethnicity:

Is the applicant a veteran?

Second head of household? Select Yes if you have a partner, spouse, roommate, or other decision-making adult in your household who would be included on applications that you complete.

YesNo

Co-Applicant

First Name:

Last Name:

Gender:

Date of Birth:

Example: 01/01/1990. You must be at least 18 years old to register for a course.

Email:

Phone:

Race:

Ethnicity:

Physical Address

Address:

If you currently do not have an address, please enter an address where you can receive mail.

City:

State/Province:

Zip/Postal Code:

DC Ward:

Primary Language Spoken:

What is your primary language?

Household Size

Please include yourself and any other people who live in the house at least 50% of the time in this number.

Annual Household Income:

Providing an accurate estimate of your annual income helps our staff to determine program eligibility. If you have no income, please enter 1 in the income field.

Do you need an interpreter?

Do children under the age of 6 live in/visit your home frequently?

Are you a female single parent?

Does anyone in your household you have a disability?

Are you a DC government employee?

Are a renter or homeowner?

Are a returning citizen?

Do you believe that you have been the victim of housing discrimination or predatory lending?

Have you recently lost your job or fear that you may lose your job?

examples: loss of income, increased expenses, illness, etc.

What best describes your experience with homelessness in the last 2 years?

New Link Is Being Used

True

I have reviewed my selections and I have not registered for more than one course!

Yes, everything looks good!

Does your registration look good to go?

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