2410 17th St NW #100,Washington, DC 20009202-667-7006
First Name: Last Name: Gender:Please select…MaleFemaleOther Date of Birth: Example: 01/01/1990. You must be at least 18 years old to register for a course. Email: Phone: Race:Please select…American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhiteAmerican Indian AND WhiteAsian AND WhiteBlack or African American AND WhiteAmerican Indian AND BlackOther multiple race Ethnicity:Please select…HispanicNot Hispanic Is the applicant a veteran?Please select…YesNo
Second head of household? Select Yes if you have a partner, spouse, roommate, or other decision-making adult in your household who would be included on applications that you complete.YesNo
First Name: Last Name: Gender:Please select…MaleFemaleOther Date of Birth: Example: 01/01/1990. You must be at least 18 years old to register for a course. Email: Phone: Race:Please select…American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhiteAmerican Indian AND WhiteAsian AND WhiteBlack or African American AND WhiteAmerican Indian AND BlackOther multiple race Ethnicity:Please select…HispanicNot Hispanic
Address: If you currently do not have an address, please enter an address where you can receive mail. City: State/Province:Please select…DCMDVAALAKAZ AR CACOCT DEFLGA HIIDIL IN IA KSKYLAMEMA MIMN MSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTWAWVWI WY Zip/Postal Code: DC Ward:Please select…N/AWard 1Ward 2Ward 3Ward 4Ward 5Ward 6Ward 7Ward 8
Primary Language Spoken:Please select…EnglishSpanishChinese – CantoneseChinese – MandarinFrenchGermanTagalogVietnameseItalianKoreanRussianPolishArabicPortugueseJapaneseFrench CreoleGreekHindiPersianUrduGujaratiArmenianASLSomaliHmongCambodianCzechIndonesianSwahiliTurkishUkrainianOther What is your primary language? Household Size Please include yourself and any other people who live in the house at least 50% of the time in this number. Annual Household Income: Providing an accurate estimate of your annual income helps our staff to determine program eligibility. If you have no income, please enter 1 in the income field. Do you need an interpreter?Please select…YesNo Do children under the age of 6 live in/visit your home frequently?Please select…YesNo Are you a female single parent?Please select…YesNo Does anyone in your household you have a disability?Please select…YesNo Are you a DC government employee?Please select…YesNo Do you believe that you have been the victim of housing discrimination or predatory lending?Please select…YesNo Have you or anyone in your household been impacted by COVID-19? Please select…YesNoexamples: loss of income, increased expenses, illness, etc. What best describes your experience with homelessness in the last 2 years?Please select…Currently HomelessExperienced homelessness some time in the last 2 yearsHave not experienced homelessness in the last 2 years I have reviewed my selections and I have not registered for more than one of each type of course (i.e. I have only registered for one Money Matters course and not two of them)!Yes, everything looks good! Does your registration look good to go? If you do not receive any e-mails within 5 minutes of submitting this form, please check your junk folder.
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