Demographic
INSTRUCTIONS: Please answer all of the questions below to the best of your ability. This form will be used to apply for financing from non-profit lenders and the Washington State Property Tax Exemption for housing programs providing housing to very low-income residents. Please complete one form per household, including multiple families. ROC Northwest / Northwest Cooperative Development Center guarantees that all information will be held in strict confidence.
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What is your lot number?   *
How many years have you lived in this home? (round to the nearest year)   *
Is this your primary residence? *
Does the owner of the home occupy the home? *
If NO, who owns the home?  
How many people live in the household and age? (including children and multiple families) *
0 people
1-2 people
3-4 people
5+ people
0-17 yrs.
18-20 yrs.
21-30 yrs.
31-40 yrs.
41-50 yrs.
51-54 yrs.
55-61 yrs.
62+ yrs.
Head of the house is a single female with children under 18? *
How many people in the household identify as: *
0 people
1-2 people
3-4 people
5+ people
White (not Hispanic)
Black (not Hispanic)
Hispanic
Asian or Pacific Islander
American Indian or Alaskan Native
Other
What is the occupation of the income earners in the household? *
Required
How many people in the household are income earners? *
0 people
1-2 people
3-4 people
5+ people
0-17 yrs.
18-20 yrs.
21-30 yrs.
31-40 yrs.
41-50 yrs.
51-54 yrs.
55-61 yrs.
62+ yrs.
Please mark the following that are true for any member of the household
0 people
1-2 people
3-4 people
5+ people
Veteran
Disabled
Clear selection
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