Please complete the below information to complete your class registration. Data collected in this intake is for informational and reporting purposes ONLY. Lacasa does not send marketing or publicity material of any kind nor sell your information to third-parties. For more information about data collection and use please see our Privacy and Program policies which may be found here: https://lacasainc.net/fec-privacy-and-program-disclosure/

 

Class Registration Intake Form

Please register me for the following class:(Required)
Please note: You will be registered for the next available class. If you are registering within 24 hours of the next class, you will automatically be placed in the following months class. If you'd like to be registered for more than one class, after you complete this intake, call our offices and let us know all the classes you'd like to be registered for. We require a new intake form if you are registering for a class more than one month from the date of your last class.
Name(Required)
Address(Required)
Please enter a number from 1 to 99.
Living at your address.
Children/people in your care.
Living Arrangement(Required)
Do you any of the below apply to you?(Required)
DD/MM/YYYY
Gender:(Required)
Marital Status?(Required)
Education(Required)
Ethnicity(Required)
Race(Required)

Income

Please answer the following questions using gross income (before taxes).
Are you employed?(Required)
We will not contact your employer unless we have your permission.
Including wages, public assistance, SSI, child support, etc.
Include all adult household members.
Do you receive Social Security or Disability benefits?
Do you receive Child Support or Alimony?
Do you receive a pension?
Do you know your credit score?(Required)
Please enter a number from 350 to 850.
I have read and accept the Program Disclosure and Privacy Policy.(Required)
Link for Privacy Policy and Program Disclosure are found here: https://lacasainc.net/fec-privacy-and-program-disclosure/ I/We hereby certify that the above information is true and complete to the best of my/our knowledge. Lacasa is a HUD approved agency and member of NeighborWorks America Network. It is extremely important for us to track the number of class participants that purchase a property. The information we collect allows us to report the impact that our services have in our community as well as to fulfill grant requirements. Data collected in this intake is for informational purposes ONLY. Lacasa does not send marketing or publicity material of any kind.
This field is for validation purposes and should be left unchanged.