10.26.16 Campbell Orientation Class

This is a registration form for the HouseKeys Home Buyer Orientation Class for the City of Campbell BMR Program being held on Wednesday, October 26, 2016 from 6:30 PM to 8:00 PM at the City of Campbell Council Chambers, 70 North First Street, Campbell, CA 95008

STOP - IMPORTANT MESSAGE

Before you begin to fill out this form, make sure you have sufficient time to slowly read each question and answer very carefully. Giving incorrect information may negatively affect you and/or slow down the process. Before you move on to the next question or section, please review your answers.

Do you have a Co-applicant?*

Yes No

Primary Applicant Name*

First Name

Last Name

Co-Applicant Name (If you don't have a co-applicant, type "n/a")*

First Name

Last Name

Primary Applicant Email*

Co-Applicant Email*

Primary Applicant Phone*

Co-Applicant Phone*

Primary Applicant: Date of Birth*

Co-Applicant: Date of Birth*

Primary Applicant: Are you currently an employee OF the City of Campbell? (A School District employee is not a City Employee)*

Yes, I'm a City Employee No, I don't work for the City of Campbell

The City of Campbell is a Municipal Corporation, whose administrative office is located at 70 N. 1st Street Campbell, CA 95008

Co-Applicant: Are you currently an employee OF the City of Campbell? (A School District employee is not a City Employee)*

I don't have a co-applicant Yes, I'm a City Employee No, I don't Work for the City of Campbell

The City of Campbell is a Municipal Corporation, whose administrative office is located at 70 N. 1st Street Campbell, CA 95008

Primary Applicant: When did you start working for the City of Campbell? Type the date*

Co-Applicant: When did you start working for the City of Campbell? Type the date.*

Primary Applicant: What is your Title or Position as a City Employee?*

Co-Applicant: What is your Title or Position as a City Employee?*

Primary Applicant: Do you currently live in the City of Campbell?*

Yes No

Co-Applicant: Do you currently live in the City of Campbell?*

I don't have a Co-Applicant Yes No

Primary Applicant: When did you move to the City of Campbell? Type the date*

Co- Applicant: When did you move to the City of Campbell? Type the date*

Primary Applicant: What is your physical address in Campbell?*

Co-Applicant: What is your physical address in Campbell?*

Primary Applicant: Are you employed within (inside) the city limits of the City of Campbell?*

Yes No

Co-Applicant: Are you employed within (inside) the city limits of the City of Campbell?*

I don't have a co-applicant Yes No

Primary Applicant: Which company do you work for and what is their address?*

Co-Applicant: Which company do you work for and what is their address?*

Primary Applicant: When did you start working within (inside) the city limits of Campbell? Type the date*

Co-Applicant: When did you start working within (inside) the city limits of Campbell? Type the date*

Primary Applicant: What city do you currently work in?*

Co-Applicant: What city do you currently work in?*

Primary Applicant: What city do you currently live in?*

Co-Applicant: What city do you currently live in? (If you don't have a co-applicant, type "n/a")*

How many people/members are in your household including yourself? (include all the people/members that will be moving in to the BMR home you are hoping to buy)*

Please do not count foster children or unborn babies. Once the baby is born, email us and we can update the household size.

List the full names AND ages of ALL the members of your household. Please include the applicant and co-applicant. (example: Jesse Jones 45, Jessica Jones 45, Jim Jr 18, Josh Jones 8, Anna Jones 5.)*

What is your TOTAL GROSS annual household income? (Include the gross income of everyone in the household that is 18 years old and over in one lump sum even if someone is not going to be on the loan or title of the home)*

Please make sure to check all boxes that apply*

I have attended a previous Campbell BMR orientation I have applied for the Campbell BMR program I have been approved as an eligible buyer for the Campbell BMR Program I have entered into a contract to purchase a Campbell BMR Property None of the above

Please Note: All applicants, co-applicants, married couples, domestic partners and anyone who can or will be on title are required to attend the HouseKeys Home Buyer Orientation for the City of Campbell before being eligible to apply for a home ownership opportunity. We are unable to give you credit for any other orientation(s) you may have attended with other agencies or NHSSV. This form does not add your name to a waiting list. This is not an Application for the BMR Program. This is only an application to register for the orientation. Thank you.

By checking the box “yes” below, I/we certify under penalty of perjury that all of the information stated on this Orientation Registration Form is true, accurate and complete. I/we have made no misrepresentations, nor did I/we omit any pertinent information. I/We authorize HouseKeys and its staff members to share our information with the City of Campbell.*

Yes, I/we certify and agree. No, I/we don't certify and don't agree

BEFORE YOU SUBMIT THIS FORM: Did you double check your answers?