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<br />ADDENDUM TO APPLICATION <br /> <br />Information for Government Monitoring Purposes <br /> <br />The information being requested below is for determining compliance with federal equal credit opportunity, fair housing <br />and home mortgage disclosure law. You are not required to furnish this information, but are encouraged to do so. The <br />law provides that a Lender may not discriminate on the basis of this information, or on whether you choose to furnish the <br />information. If you choose not to furnish this information and you have made the application in person, we are required to <br />note ethnicity, race and sex on the basis of visual observation or surname. Please check below if you choose not to <br />furnish the inforn1ation. <br /> <br />DATE OF APPLICATION:____________________ <br /> <br />APPLICANTCO-APPLICANT <br /> <br />APPLICANT NAME: <br /> CO-APPLICANT NAME: <br /> <br />o <br />o <br /> I do not wish to furnish this information <br /> I do not wish to furnish this information <br /> <br />ETHNICITY: <br />(select only one) ETHNICITY: <br />(select only one) <br />o <br />o <br /> Hispanic or Latino <br /> Hispanic or Latino <br />o <br />o <br /> Not Hispanic or Latino <br /> Not Hispanic or Latino <br />oo <br />oo <br />GENDER: <br /> Female Male GENDER: <br /> Female Male <br />RACE: <br />(select one or more) RACE: <br />(select one or more) <br />o <br />o <br /> White <br /> White <br />o <br />o <br /> Black/African American <br /> Black/African American <br />oo <br /> Asian Asian <br />oo <br /> American Indian/Alaska Native American Indian/Alaska Native <br />oo <br /> Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander <br />o <br />o <br /> American Indian/Alaska Native & White <br /> American Indian/Alaska Native & White <br />o <br />o <br /> Asian & White <br /> Asian & White <br />o <br />o <br /> Black/African American & White <br /> Black/African American & White <br />o <br />o <br /> American Indian/Alaska Native & Black/African <br /> American Indian/Alaska Native & Black/African <br />American American <br />o <br />o <br /> Other Multi Racial <br /> Other Multi Racial <br /> <br /> <br />______________________________________ ___________________________________ <br />APPLICANT SIGNATURE CO-APPLICANT SIGNATURE <br /> <br />This Section For Lender Use <br />Greater Metropolitan Housing Corporation <br /> <br />Application received by:  mail  face-to-face interview  telephone <br /> <br />Staff Name: ___________________________________________ Date:_____________________________ <br /> <br /> <br />181302v1 <br />14 <br />