JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Homeowners Assistance Fund (HAF) Program Virtual Workshop Sign Up Sheet
Please complete the sign-in sheet if you wish to attend an upcoming workshop for the HAF Program. We plan to offer both in-person and virtual workshops. We will contact you as soon a we schedule these community workshops.
* Indicates required question
Email
*
Record my email address with my response
Full Name | First & Last
*
Your answer
Email Address
*
Your answer
Reconfirm Email Address
*
Your answer
Phone Number
*
Your answer
Alternate Phone Number
*
Your answer
Is there an open mortgage in your name on your home?
*
Yes
No
Was your ability to pay mortgage and/or utilities affected by the COVID-19 pandemic?
*
Yes
No
What is your monthly mortgage payment amount?
*
Your answer
Who is your mortgage lender? (Bank)
*
Your answer
What is your monthly household income? (please include all employed household members total gross salary for the month)
*
Your answer
What village is your home located in?
*
Your answer
What is your average monthly ASPA bill?
*
Your answer
What is your average monthly internet bill?
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of American Samoa Government.
Report Abuse
Forms
