Request edit access
Will County Center for Community Concerns (WCCCC) Homebuyer Education Class Online Enrollment Form  
This form must be completed in full in order to participate in class and receive a Certificate of Completion.

As a government funded agency, WCCCC is required to collect data on all class attendees. Please be assured that your information is confidential and is only being used to provide aggregate statistics.

Sign in to Google to save your progress. Learn more
Which class would you like to register for? *
First Name *
Last Name *
Date Of Birth *
Social Security *
Phone Number (Please specify whether this is home, cell or work #) *
Current Address *
City *
State *
Zip Code *
What County do you Live in? *
Do you reside in a rural area? *
Email Address *
Please check the racial category that best describes you *
Are you of Hispanic ethnicity? *
Is your household limited English proficient? *
What is the primary language spoken in your household? *
Citizenship Status *
Please select the number or people in your household including children *
How many dependents do you have? *
Marital Status *
Gender *
Estimate your total Yearly Household Gross (before taxes) Income. Include ALL income sources *
Military Status *
Are you a farm worker? *
Are you Disabled? *
Are you a first-time home buyer? *
Highest level of Education *
How long have you been at your current job? *
I am taking this class because *
How did you hear about this class? *
Please add your initials below to acknowledge receipt of the following disclosures/resources: For your protection, Get a home inspection; Ten Important Questions to ask your home inspector; Fair Housing Information; Protect your Family from Lead Based Paint. *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Will County Center for Community Concerns. Report Abuse