2. First Name*
   Head of Household/Person that will be listed on the application
3. Last Name*
5. Email Address*
6. Verify Email Address*
8. Phone Number*
9. Verify Phone Number*
11. Date and time of when the video was viewed*
    Date and time of when the video was viewed

    Date and time of when the video was viewed
13. By checking the following box, you acknowledge that you have watched the First-Time Homebuyers Orientation video, and understand the process in order to submit your application.*

    1. I acknowledge that I have completed the Orientation Session Video
15. *Please verify all information has been entered correctly before submitting.
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field