Homeownership Application
This is an application for home ownership assistance through Village Cohousing Works.
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Email *
Name 
(first and last)
 *

Phone Number (including area code)

Please include your number so we have a backup way to reach you. Sometimes our emails are sent to SPAM. We will never share your information without your permission.

 *
Mark any you have experience with.
Ethnicity 
What are your living circumstances today? (choose one)
 *
If other, describe:

What is the condition of your current residence?

(choose one) :


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Comments on above.

Please describe the most difficult problem you face regarding housing: 


 *

Family/Household Size


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How many dependents?

 *
What ages are your dependents?

Household Type (please select the most accurate)

 *

Are there non-dependents who will be living in the home? If yes, list below: Relationship, Age


What does it mean to you to have control over your own home?

If you lived in a community, would you be willing to: (Check all that apply)

 *
Required

How important would it be for you to have a say in how your community operates?

Clear selection
Do you have access to a drivable car?
Clear selection
What is your monthly income before taxes? (what did you make last month?)
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Does anyone else in your household have income? If so, how much did they make last month?
Clear selection
Do you have a Social Security Number?
*
Have you been evicted for lack of payment in the last two years?

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Are you getting calls and letters from a debt collection agency?
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I am interested in learning more  . . . *
Required
Would you need classes or meetings to be near you? What would be a convenient location?
Clear selection
How did you hear about us?  *
Please add our email address contactvcw@gmail.com to your contact list to ensure you receive our email notifications.
A copy of your responses will be emailed to the address you provided.
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