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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.


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Which class would you like to register for? *
First Name *
Last Name *
Date Of Birth *
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DD
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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 *
Required
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. *
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