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Depending on your answers, you may be presented with additional questions. To ensure the most accurate results, you should answer all the questions listed. You may click the 'Stop and View Results' button at any time to review results based on the answers you already submitted. Your answers are used only to determine potential qualification. GovLoans.gov does not keep any data you enter. 		Stop and view results

1.
What is your citizenship status in the US?
US Citizen
US National
Permanent Resident
Legal alien
Other
No Answer
2.
What is your race/ethnicity?
African American
Alaskan Native
Amerasian
Caucasian
Asian
Cuban
Haitian
Hispanic
Native American /American Indian
Native Hawaiian/Pacific Islander
3.
Describe your current and past professional experiences.(check all that apply)
Agricultural producer / Farmer
Aquaculture operator
Clinical research
Coal miner
Dairy farmer
Educator (teaching, training)
Elected official
Emergency response worker
Federal employee
Firefighter
Fisherman
Health care professional
Law enforcement officer
Long shore or harbor worker
Migrant or seasonal farm worker
Military
Musician
Post-doctoral research
Practicing artist
Published writer / Poet
Railroad worker
Rancher
Translator
4.
Are you a current or prospective student?
Yes
No
No Answer
5.
What is your current marital status?
Divorced
Married
Remarried
Single
Widow(er)
6.
Are you the spouse or surviving dependent of a veteran(alive or deceased)?
Yes
No
No Answer
7.
Indicate if you or any of your family/household members have a disability.
Child(ren)
Spouse
Parent
Self
None of the above
8.
How would you characterize your income?
Above average income
Moderate income
Low income
Very low income
No Answer
9.
Do you have debt in any of the following areas?(check all that apply)
Delinquent federal debt
Housing debt/mortgage
Education Loans
10.
What describes your current housing / living situation?(check all that apply)
Live in or own a condominium
Member of a housing cooperative
Live in a high-poverty community
Homeless / Live in a Shelter
Current or prospective homeowner
Live on or near an Indian reservation
In need of aid to obtain decent, safe, and/or sanitary housing
At risk for exposure to lead poisoning
Damaged by a Presidentially declared disaster
Live in public housing
Renting
Live in a rural area
Lost the majority of income because an employer or business was harmed by either a Presidentially declared disaster or closures mandated by a government agency
11.
Are you in need of assistance or guidance regarding any of the following?(check all that apply)
Disaster relief
Addressing the problems of drug-related crime in your neighborhood
Land or property ownership
Literacy program for incarcerated adults
Training or retraining to develop new job skills
Veteran burial issues
12.
Are you or a family member enrolled in a federally recognized American Indian tribe or Alaskan Native village?
Yes
No
No Answer
13.
How many years of experience do you have in your current profession? Example: 12
14.
What is your current military status?
Active
Previously active
Reserve
Veteran
No Answer
15.
On what date(mm/dd/yyyy) did you, your parent or your spouse begin military service?
16.
Did you complete at least 24 continuous months of active duty service?
Yes
No
No Answer
17.
If you or a family member were in the active military service, what was the discharge status of the individual? (skip if not applicable)
Dishonorable
General
Honorable
No Answer
18.
Do you or your family member have a military service-connected disability, injury, or disease?
Yes
No
No Answer
19.
Do you have a family member who died due to any of the following?(check all that apply)
While serving in the military active duty
Terrorist-related aircraft crashes on September 11, 2001
As a result of a service-connected disability/injury
20.
What field of study are you currently or intending to pursue?(check all that apply)
Arts
Child care
Clinical research
Education
Emergency management
Engineering
Health care
Housing or urban development issues
Humanities
Mathematics
Medical
Modern foreign language studies
National fire academy studies
Natural sciences
Post-doctoral research
Public service
Social sciences
University
Other
21.
What degree are you pursuing?
22.
Describe your parental or caregiving situation.(check all that apply)
Adoptive parent
Child has special needs
Need help to ensure child is not separated from your home
Responsible for a child who is too young for public school
Responsible for a child experiencing developmental delays (cognitive, physical, communication, social, emotional or self-help)
Need help collecting child support
Foster caregiver
Responsible for a child(ren) who attends school (high school or under)
Need assistance paying for child care
Owe child support and need help with payments
Has custody of a child with a parent living outside the home
Responsible for a child(ren) who is a current or prospective college student
23.
Are you in need of any of the following?(check all that apply)
Adaptive equipment for disabilities
Prosthetic aid (such as an artificial limb, braces, orthopedic shoes or wheelchair)
Training or retraining to develop new job skills
24.
Do you or any of your family/household members have any of the following conditions?(check all that apply)
Blindness
Hereditary blood disorder
Drug or alcohol dependency
HIV or AIDS
Limb differences
Limb loss
Mental illness
Paralysis
Permanently (rated 100%) disabled from a service-connected condition
Pregnancy
End-stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
Spina Bifida(not including spina bifida occulta)
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