| Field | Description |
| Personal Information |
| First Name | First name of the appraiser. |
| Middle Initial | Middle initial of the appraiser. |
| Last Name | Surname of the appraiser. |
| Suffix | Suffix after the appraiser's Last Name (e.g., Jr. or III.), |
| Date of Birth | Month, day, and year of the appraiser's birth. |
| Social Security Number | Social Security Number of the appraiser. |
| Gender | Gender of the appraiser. |
| Ethnicity | Indicator specifying whether the appraiser is of Latino or Hispanic descent. |
| Race(s) | Racial background of the appraiser. |
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| Contact Information |
| Home Address |
| Street Address | Street address of the appraiser's residence. |
| City | City in which the appraiser resides. |
| State | State in which the appraiser resides. |
| Zip Code | U.S. Postal Service Zonal Improvement
Plan (ZIP) code for the geographic location of the appraiser's residence. |
| Is mailing address the same as home address? | Indicator specifying whether the appraiser's home address and mailing address are the same. |
| Mailing Address |
| Business Name | Business name under which the appraiser works. |
| Street Address | Street address to which the appraiser's business mail is sent. |
| City | City to which the appraiser's business mail is sent. |
| State | State to which the appraiser's business mail is sent. |
| Zip Code | Zip code to which the appraiser's business mail is sent. |
| Contact Information |
| Phone Number | Telephone number of the appraiser. |
| Fax Number | Fax number of the appraiser. |
| E-mail Address | Electronic mail address of the appraiser. |
| Confirm E-mail | Repeat of the
appraiser's electronic mail address for verification. |
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|
Credential Information
|
| Credential Type | Classification of the appraiser's license. |
| State | State in which the appraiser is certified/licensed. |
| Credential Number | Appraiser's state license number. |
| Expiration Date | Month, day, and year the license expires. |
| Appraiser Certification |
| Acceptance and Signature |
Full name of the appraiser (excluding name suffix) used as the:
| • |
Appraiser's electronic signature confirming agreement and compliance with the terms stated in the Appraiser Certification. |
| • |
Appraiser's electronic signature on the subsequent form HUD-92563-A, Application for Roster Personnel Designation. |
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