Frameworks Intake Form Disclosure Statement - Acknowledgement After reading, please sign the acknowledgment at the bottom of this page. Valley Community Development’s Sustainable Homeownership Center provides a variety of services. We provide first-time homebuyer readiness counseling including financial literacy, budgeting, foreclosure prevention services, first-time homebuyer workshops, and post-purchase workshops. We provide technical assistance to help access down payment assistance when available. Additionally, we market affordable housing units available for sale to income-eligible first-time buyers. Valley Community Development will follow strict rules to protect your confidentiality. The personal data collected below including name, street address, email address, and any other personally identifiable information is protected by the Privacy Act. You will never be named in any reports. Your responses may be looked at individually by the funding source, or contractors hired by the funding source to collect and analyze data, your name or street address will not be reported. Income, city, state, zip code, family size, and other demographic data will be reported. Contractors of HUD/DHCD or any City/State agency are covered by the same Privacy Act requirements to protect your privacy and staff must demonstrate that they have systems in place to protect against data disclosure. Funding Sources Include:Massachusetts Department of Housing and Community Development (DHCD)Community Economic Development Assistance Corporation (CEDAC)Citizens Housing and Planning Association (CHAPA)Mass Housing Partnership Fund Board (MHP)Massachusetts Rehabilitation Commission (MRC)City of NorthamptonTown of Amherst – Amherst Community Land TrustMA Division of Banks (DOB)Florence BankbankESBPeoplesBankGreenfield Cooperative BankGreenfield Savings BankCountry BankBerkshire BankPrivate donors through annual fundraising efforts and Community Investment Tax Credits (CITC)Valley Community Development’s workshop/webinar participants are not required to utilize other programs provided by Valley to receive counseling of any type. Counseling services are free of charge and there are no income restrictions for homeownership or foreclosure prevention counseling to Hampshire County Residents;however, it is our goal to serve households at or below 80% of area median income, people of color, and minority households who may be underserved in our community. You are under no obligation to utilize any of Valley’s services or programs or to purchase or rent property owned by Valley in order to receive counseling services.You are under no obligation to utilize the services provided by any of Valley’s funding sources or by any of our business partners. A list of funding sources is included in each participant's workshop materials. Valley provides written and verbal disclosures at the beginning of each class andencourages participants to shop around. Ok By entering your name and checking the box above, you acknowledge that you have read the above disclosure. If a second household member will be participating with you, they must also read the above and type their name here in acknowledgement. If you are taking this course alone, please type N/A. Please select the session you are signing up for:Please select... May Frameworks Workshop June Frameworks Workshop Contact Information & Demographics First Name Last Name Email Phone Cell / Alternate Phone Providing this info is optional but it is needed for reporting and statistical purposes. GenderMaleFemaleNonbinaryOther Are you 60 or more years of age?YNChoose not to respond Are you disabled?YNChoose not to respond Are you a Veteran?YesNoChoose not to respond Select the race(s) with which you most closely identifyPlease select... American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pac. Is. White Other Other multiple race Chose not to respond Unknown In addition to the above, do you consider yourself Hispanic?Hispanic or LatinoNon-Hispanic or LatinoChose not to respond Do you have a spouse or partner who would like to register?Please select... Yes No Spouse or Partner Information & Demographics First Name Last Name Email Phone Cell / Alternate Phone GenderMaleFemaleNonbinaryOther Are you 60 or more years of age?YNChoose not to respond Are you disabled?YNChoose not to respond Are you a Veteran?YesNoChoose not to respond Select the race(s) with which you most closely identifyPlease select... American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pac. Is. White Other Other multiple race Chose not to respond Unknown In addition to the above, do you consider yourself Hispanic?Hispanic or LatinoNon-Hispanic or LatinoChose not to respond If you live in a single parent household, please state the gender of the head of household:Male FemaleNot Applicable Address City State Zip Code How many people live in your household? Combined gross annual income What is your monthly housing payment? If you have already been approved for a mortgage, what type do you have?MHP ONE MortgageConventionalFHAUSDAOtherNot sureI have not been approved yet Which mailing lists would you like to subscribe to? Monthly Newsletter Homeownership Program Information Small Business Assistance Information Affordable Housing News How did you hear about us? Please select... Word of Mouth Website Facebook Twitter Instagram LinkedIn Flyer Other Other reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. 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