Homebuyer Education Registration Form In order to keep our homebuyer education courses free for attendees, we depend on public funding from state and local agencies. These agencies require us to collect the following data points about our registrants in order to gather demographic information about homeownership in Washington State. Parkview Services will not share any of your information with third party agencies aside from this reporting, which is important to our ability to continue to provide no-cost education to the public. Name* First Last Choose class date*Jan. 22nd & 24thJan. 26thFeb. 19th & 21stFeb. 23rdMar. 26th & 28thMar. 30thApr. 23rd & 25thApr. 27thMay 21st & 23rdMay 25thJun. 25th & 27thJun. 29thJul. 23rd & 25thJul. 27thSept. 28thOct. 22nd & 24thOct. 26thNov. 26th & 28thNov. 30thDec. 28thWill another person from your household be attending with you?* Yes No Additional Attendee Name First Last Additional Attendee Gender* Female Male Other/Prefer not to say Additional Attendee Race*American Indian or Alaskan NativeAmerican Indian or Alaskan Native & Black or African AmericanAmerican Indian or Alaskan Native & WhiteAsianAsian & WhiteBlack or African AmericanBlack or African American & WhiteChoose not to respondNative Hawaiian or other Pacific IslanderOtherWhiteAdditional Attendee Ethnicity*HispanicNon-HispanicPrefer not to sayAdditional Attendee Age*Gender* Female Male Other/Prefer not to say Race*American Indian or Alaskan NativeAmerican Indian or Alaskan Native & Black or African AmericanAmerican Indian or Alaskan Native & WhiteAsianAsian & WhiteBlack or African AmericanBlack or African American & WhiteChoose not to respondNative Hawaiian or other Pacific IslanderOtherWhiteEthnicity*HispanicNon-HispanicPrefer not to sayPrimary Language*Phone*Email* Age*Level of Education*HS DiplomaNo HS DiplomaGEDVocational CertificateSome CollegeAssociates DegreeBachelors DegreeMasters DegreeDoctorateDo you require an interpreter or other accommodation?* Yes No Veteran Status* Yes No Prefer not to say Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Household Type*Single AdultFemale-headed single parent householdMale-headed single parent householdMarried Without DependentsMarried With DependentsTwo or More Unrelated AdultsOtherTotal Monthly Household Income (can be estimated)*Number of People in Household*
