eligibility form

Last Name*

First Name*

Middle Initial

Employer:*

Employee Status:
Full-TimePart-Time

If Partā€Time, how many hours per week:

Home Buying Status:*
I am a first time home buyerI am NOT a first time home buyer

Employee ID Number:*

Department:*

Campus Box/Mailstop:

Current Home Address*

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Home Phone:*:

Work Phone:*

Email:*

How did you hear about the Employer Assisted Housing Program?*

I confirm I have read the Official Program Rules