Department of Housing and Economic Development (HED)

REGISTRATION FORM

This form is not compatible with Internet Explorer. Please use Chrome, Edge, Safari, or Firefox.

Select One: *This question is required.

Workforce Housing Program Mandatory Orientation

Date: *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Applicant’s Name: *This question is required.

Co-Applicant’s Name:

Street Address: *This question is required.

City: *This question is required.

Zip/Postal Code: *This question is required.

Email Address: *This question is required. This question requires a valid email address.

Telephone: *This question is required.

1. What is your estimated annual gross household income? This question requires a valid currency format.

2. How many people live in your household?

3. Do you currently own a home?

*In order to qualify, your company must be located in Palm Beach County, and the office you are assigned to must provide space for you in the County.

Do you currently work in Palm Beach County? *This question is required.

E-mail Disclaimer:

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

PBC reCAPTCHA