Address Yourself Enrollment Form
CLIENT INFORMATION
Last Name:
First Name:
Middle Initial
Email Address:
Phone Number
Current Address
Living Situation
Rent
Own
Live with Family/Friends
Rent per Month
Mortgage lender name:
Other Lender:
Are you under contract to purchase a property?
Yes
No
Where is the property located?
The following information will not be used to determine your eligibility for any of our programs. It is gathered to help us describe out clients to the investors who enable New Jersey Community Capital to provide homeownership programs.
Race:
Black or African American
White
Native/Indigenous
Asian
Pacific Islander
Two or more Races
Prefer not to say
Ethnicity:
Hispanic or Latinx
Not Hispanic or Latinx
Do you identify as LGBTQIA?
Yes
No
Gender:
Male
Female
Other
Prefer not to respond
Military Status:
None
Active
Veteran
Will there be a co-borrower on the first mortgage?
Yes
No
Note: All borrowers listed on the first mortgage must be included in this enrollment form.
GENERAL INFORMATION
New Jersey county(s) where you're interested in purchasing:
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
Ocean
Passaic
Salem
Somerset
Sussex
Union
Warren
Are you purchasing in Atlantic City?
Yes
No
Are you purchasing in New Brunswick?
Yes
No
Household Size (including yourself):
Has any adult in your household owned a home in the last three years?
Yes
No
Are you or any adult in your household an employee of AtlantiCare?
Yes
No
Are you or any adult in your household an employee of Capital Health?
Yes
No
How did you hear about us?
Please select...
AtlantiCare
CAPC
Capital Health
East Trenton Collaborative
Habitat for Humanity
Housing Counselor
Mortgage Lender
New Brunswick Tomorrow
Online Search
Other
Real Estate Agent
Trenton Neighborhood Initiative
Trenton Health Team
CO-CLIENT INFORMATION
Last Name:
First Name:
Middle Initial
Email Address:
Phone Number
The following information will not be used to determine your eligibility for any of our programs. It is gathered to help us describe out clients to the investors who enable New Jersey Community Capital to provide homeownership programs.
Race:
Black or African American
White
Native/Indigenous
Asian
Pacific Islander
Two or more Races
Prefer not to say
Ethnicity:
Hispanic or Latinx
Not Hispanic or Latinx
Do you identify as LGBTQIA?
Yes
No
Gender:
Male
Female
Other
Prefer not to respond
Military Status:
None
Active
Veteran
Is there another co-borrower to add?
Yes
No
Note: All borrowers listed on the first mortgage must be included in this enrollment form.
CO-CLIENT INFORMATION
Last Name:
First Name:
Middle Initial
Email Address:
Phone Number
The following information will not be used to determine your eligibility for any of our programs. It is gathered to help us describe out clients to the investors who enable New Jersey Community Capital to provide homeownership programs.
Race:
Black or African American
White
Native/Indigenous
Asian
Pacific Islander
Two or more Races
Prefer not to say
Ethnicity:
Hispanic or Latinx
Not Hispanic or Latinx
Do you identify as LGBTQIA?
Yes
No
Gender:
Male
Female
Other
Prefer not to respond
Military Status:
None
Active
Veteran
Is there another co-borrower to add?
Yes
No
Note: All borrowers listed on the first mortgage must be included in this enrollment form.
CO-CLIENT INFORMATION
Last Name:
First Name:
Middle Initial
Email Address:
Phone Number
The following information will not be used to determine your eligibility for any of our programs. It is gathered to help us describe out clients to the investors who enable New Jersey Community Capital to provide homeownership programs.
Race:
Black or African American
White
Native/Indigenous
Asian
Pacific Islander
Two or more Races
Prefer not to say
Ethnicity:
Hispanic or Latinx
Not Hispanic or Latinx
Do you identify as LGBTQIA?
Yes
No
Gender:
Male
Female
Other
Prefer not to respond
Military Status:
None
Active
Veteran
If you receive an error when submitting this form please contact us via email at
addressyourself@newjerseycommunitycapital.org
Contact Information