1.What is your gender?
Female
Male
2.What is your citizenship status in the U.S.?
US Citizen
US National
Permanent Resident
Legal Alien
Other
3.What is your current marital status?
Divorced
Married
Re-Married
Single
Widowed
4.Do you have a U.S. Drivers license or ID?
Yes
No
|
5.How much credit card debt would you like to pay off with your grant?
| Estimated Total Debt |
|
|
Yes, I want a credit counselor to contact me regarding my debt. |
|
6.What is the payment status of your credit card bills?
7.
How much housing debt (mortgages &
equity lines) would you like to pay off with your grant?
|
Estimated Total Debt |
|
8.What is the payment status of your housing debt?
9. If you qualify, what is the best time to contact you?
Morning
Afternoon
Evening |
