HomeSTL Questionnaire First Name: Last Name: Email: Phone: Date of Birth: Occupation: Home Buyer Contact Number: Home Buyer Email Address: Home Buyer Owned a Home in the Last 3yrs: --None-- Yes No Where are you in the Home Buying Process: --None-- Ready Getting Ready Getting Started Current Address Street: Current Address City: Current Address State: Current Address Zip: # of Household Members: # of Household Members 18+ Working: Annual Household Income: Current Credit Report: --None-- Yes No Credit Score: --None-- 0 - 550 551 - 599 600 - 650 651 - 750 751+ Completed HUD Certified Course?: --None-- Yes No HUD Certified Course Organization: Property Street Address: Property City: Property State: Property Zip: Submitted an offer to purchase?: --None-- Yes No Date of Offer Submission: How did you hear about the product?: --None-- Social Media Friend Family City Employee Mortgage Lender Other If Lender, Provide Name: If other, please describe.: If you are approved to receive funding from this program, would you be willing to have your experience featured for SLDC’s marketing and promotional purposes? --None-- Yes No
