IZ Orientation Short Intake
Please complete this intake prior to attending the virtual workshop to receive the log in instructions.
* Required
Email address
*
Your email
Which session will you be attending ?
Choose
Thursday February 11th 2021 4pm to 6pm
Thursday March 11th 2021 4pm to 6pm
First and Last Name:
*
Your answer
Home Address
*
Your answer
Are you an Eckington Neighborhood or Ward 5 Resident?
*
Choose
Yes, I am an Eckington Neighborhood Resident
Yes, I am a Ward 5 Resident
No
Phone Number
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
How did you hear about LEDC?
*
Choose
Radio
Flyer
Newspaper
Word of Mouth
Other
Race:
*
Choose
American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Other Pacific Islander
White
Other
Ethnic Origin:
*
Choose
Hispanic or Latino/a
Not-Hispanic or Latino/a
Country and Language of Origin
*
Your answer
Number of People in Household:
*
Choose
1
2
3
4
5
6
7
8
9
10
Gender:
*
Choose
Male
Female
Other/Non-Conforming
Education
*
Choose
Primary
High School
College
Vocational
Other
Marital Status:
*
Choose
Single
Married
Separated
Divorced
Other
Labor Status:
*
Choose
Full Time
Part Time
Self Employed
Retired
US Veteran:
*
Choose
Yes
No
Household Income
Please provide one of the following in the next question: hourly rate, monthly gross income, or yearly gross income
Household Income
*
Your answer
Disclosure to Client for HUD Housing Counseling Services
Latino Economic Development Center
Services Offered:
Our agency provides the following HUD one-on-one housing counseling services:
rental topics; pre-purchase/homebuying; non-delinquency post-purchase; home maintenance and financial management for homeowners; and resolving or preventing mortgage delinquency or default counseling.
Our agency also provides the following services and group education workshops: financial literacy; fair housing; pre-purchase/homebuyer education; non-delinquency post-purchase; resolving or preventing delinquency; tenant rights and other workshops as required by local assistance programs; small business development support, small business loans, and Lending Circles.
Relationships with Industry Partners:
Our agency has financial or exclusive relationships, or both, with specific industry partners, including: Virginia Housing Development Authority, DC Department of Housing and Community Development, Maryland Department of Housing and Community Development, Greater Washington Urban League, DC Housing Finance Agency, Baltimore City Department of Housing and Community Development, UnidosUS, United States Department of Housing and Urban Development, Wells Fargo, Citi Bank, Bank of America, Capital One Bank, and HSBC Bank USA.
No Client Obligation:
There is no obligation to receive, purchase, or use any product or service offered by this agency or any services of its industry partners or other party in exchange for your receiving HUD housing counseling services.
Alternatives:
As a condition of our services, and in alignment with meeting our counseling goals, and in compliance with HUD’s Housing Counseling Program requirements, we may provide information on alternative services, programs, and products available to you, if applicable and known by our staff.
I have read and received a copy of this disclosure.
Date This Form Was Completed:
*
MM
/
DD
/
YYYY
Type Your Name Confirming: This disclosure was conveyed verbally via a virtual/telephonic session.
*
Your answer
Complete Your Entry
Please send a copy of your ID to:
housing@ledcmetro.org
or text a picture of your ID to:240-705-9749
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
