Tester ID
Race
If you chose other as your race, please specify:
National Origin
What sex was recorded on your original birth certificate?
Are you currently employed?
Are you currently attending school?
If you are currently attending school, provide the name of school, location, deg
Highest Level of Education Completed
Your Estimated Gross Annual Income
Your family’s estimated gross annual income (i.e., the shared gross annual incom
Length of Time at Current Residence
Do you presently rent or own your home?
If you have another type of living situation aside from renting or owning your o
Type of Dwelling
If you chose other as your type of dwelling, please specify:
Are you looking to rent or purchase housing at the present time or within the ne
If looking to rent or purchase housing at the present time or within the next se
Have you ever been a tester?
If you have ever been a tester, estimate how many tests you have done
No. of Rental tests completed
No. of Sales tests completed
No. of Lending tests completed
No. of Insurance tests completed
No. of Employment tests completed
No. of Public Accommodations tests completed
No. of Other tests completed
If you have completed Other types of tests, specify
Do you have any prior experience using a computer (e.g., word processing, data e
If you have any prior experience using a computer, please describe.
Date  (mm/dd/yyyy)
Was the applicant selected?
Is this applicant proficient in reading and writing in English?
Is this applicant fluent in English?
If you chose other as your first language, specify
If fluent in English, does this applicant have a discernible accent of any kind?
If the applicant has a discernible accent of any kind, describe.
Is this applicant's race or ethnicity clearly visibly discernible?
Date tester attended training session  (mm/dd/yyyy)
Date tester completed practice tests  (mm/dd/yyyy)
This form is complete
What is your first language?
Do you or a member of your immediate family presently work for, serve on the boa
If you or a member of your immediate family presently work for, serve on the boa
Do you hold any views, positive or negative, about any segment of the housing in
If you hold any views, positive or negative, about any segment of the housing in
One part of testing is playing an assigned role and assuming characteristics, wh
If you have any reservations (religious or otherwise) about providing informatio
Do your current professional or volunteer activities in the community give you s
Is there any reason you can think of that might make it difficult for you to mai
If there is any reason you can think of that might make it difficult for you to
What position is this applicant applying for?
Do you have a valid driver’s license?
Do you own or have regular access to a vehicle that you can use for testing?
Are you willing to travel for testing?
Age
What is your current gender identity?
If you chose other as your current gender identity, please specify:
Please indicate your sexual orientation:
If you chose other as your sexual orientation, please specify:
If Yes, are you currently employed on a full-time or part-time basis?
If Yes, are you currently attending school on a full-time or part-time basis?
People can tell I’m transgender/gender non-conforming even if I don’t tell them.
Have you legally changed your name?
Do you live in shared housing (group home, with roommates, etc.)?
Do you have a Government issued driver’s license
Does the government issued driver’s license match your gender identity and name?
Is the government issued driver’s license current or expired?
Expiry Date of government issued driver’s license:
Do you have a provincial/territorial or state identification card?
Does the provincial/territorial or state identification card match your gender i
Is the provincial/territorial or state identification card current or expired?
Expiry Date of the provincial/territorial or state identification card:
Do you have a U.S. passport or passport card?
Does the U.S. passport or passport card match your gender identity and name?
Is the U.S. passport or passport card current or expired?
Expiry Date of the U.S. passport or passport card:
Do you have a permanent resident card?
Does the permanent resident card match your gender identity and name?
Is the permanent resident card current or expired?
Expiry Date of the permanent resident card:
Do you have a US Military ID or dependent card with photo?
Doesthe US Military ID or dependent card with photo match your gender identity a
Is this identification current or expired?
Expiry Date of the US Military ID or dependent card with photo:
Do you have any other type of identification?
Does this other type of identification match your gender identity and name?
Is this other type of identification current or expired?
Expiry Date of other type of identification:
If you have an other type of identification, please specify: