Client Demographics Survey


In order for Next Step, KC to collect demographic information, your voluntary completion of the following information is requested. This information will be kept separate from your loan application and will be kept confidential. Refusal to provide this information will not subject you to differential treatment. 

Borrower Information
Address *
Address
Best phone number to reach you *
Best phone number to reach you
Date of Birth
Date of Birth
Demographic Information
Please select the number of individuals currently living in your household.
Please enter the total household income which includes all household member's employment wages, benefits, and other taxable income.
$
Ethnic Group *
Please select the ethnic group you most identify with
A disability is a physical or mental impairment which substantially limits one or more major life activities. You can be considered as having a disability if you had a record of such impairment or if you are regarded as having a disability.
Please enter your initials and submit