Rental-intake

Counseling Intake Form

All fields must be completed to register for NeighborWorks® Boise’s HUD Counseling services. If you have questions, please contact: home@nwboise.org, (208)258- 6225.

This field is for validation purposes and should be left unchanged.

How did you hear about us? Who referred you?(Required)

PERSONAL INFORMATION – APPLICANT

Your Name(Required)

Prefix First Middle Last

Veteran?(Required)

Yes

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Cell Phone

SSN#(Required)

Birthday(Required)

Household Type:

Single adult

Married without children

Married with children

Two or more unrelated adults

Female-headed single parent household

Male-headed single parent household

Other

Household Type (Other)

# of people in household

Ages of dependent children

Is there a co-applicant?(Required)

Yes

PERSONAL INFORMATION | CO-APPLICANT

Your Name(Required)

Prefix First Middle Last

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Veteran?

Yes

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the organization’s compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that an organization may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this organization is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish this information, please check the box below.

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I do not wish to furnish this informtion

Ethnicity

Co-Applicant Ethnicity

Race:

Co-Applicant Race:

Gender

Co-Applicant Gender

Education

Co-Applicant Education

APPLICANT EMPLOYMENT

Primary Employer:

Hire Date:

Title:

Part-time

Full-time

Not Employed

Gross Income (Before Taxes):

I am Paid:

Address

Street Address City State ZIP Code

SECONDARY EMPLOYER

Employer:

Hire Date:

Title:

Full or Part Time

Part-time

Full-time

Gross Income (Before Taxes):

I am Paid:

IF EMPLOYED FOR LESS THAN TWO YEARS AT ONE PLACE, CONTINUE LISTING EMPLOYERS BELOW:

CO-APPLICANT EMPLOYMENT

Primary Employer:

Hire Date:

Title:

Co-Applicant Full or Part Time

Part-time

Full-time

Gross Income (Before Taxes):

I am Paid:

Address

Street Address City State ZIP Code

CO-APPLICANT SECONDARY EMPLOYMENT

Employer:

Hire Date:

Title:

Part-time

Full-time

Gross Income (Before Taxes):

I am Paid:

Address

Street Address City State ZIP Code

IF EMPLOYED FOR LESS THAN TWO YEARS AT ONE PLACE, CONTINUE LISTING EMPLOYERS BELOW:

APPLICANT INCOME

Please enter monthly amounts of the following income types:

Salary

Pension Income

Dependent SSI Income

Alimony/Child Support

Public Assistance

Disability Income

Rental Income

Self-Employment Income

Seasonal Employment

Can you document your child support/alimony income?

Yes

If yes, how long will it continue?

If your child or a family member receives SSI, how many more years will the payments continue?

If you receive disability income, is it for a permanent disability?

Yes

Regarding seasonal employment, have you worked in this field for two or more years?

Yes

CO-APPLICANT INCOME

Please enter monthly amounts of the following income types:

Salary

Pension Income

Dependent SSI Income

Alimony/Child Support

Public Assistance

Disability Income

Rental Income

Self-Employment Income

Seasonal Employment

LIABILITIES/DEBT

Please list any debts you have, including credit cards, auto loans, student loans, and child-care expenses. Do NOT include rent or utilities. Choose A for Applicant, C for Co-Applicant in “Whose Debt?” field.

Paid To (Debtor #1)

Current Balance

Monthly Payment

Whose Debt?

Paid To (Debtor #2)

Current Balance

Monthly Payment

Whose Debt?

Paid To (Debtor #3)

Current Balance

Monthly Payment

Whose Debt?

Paid To (Debtor #4)

Current Balance

Monthly Payment

Whose Debt?

Paid To (Debtor #5)

Current Balance

Monthly Payment

Whose Debt?

Paid To (Debtor #6)

Current Balance

Monthly Payment

Whose Debt?

Paid To (Debtor #7)

Current Balance

Monthly Payment

Whose Debt?

Paid To (Debtor #8)

Current Balance

Monthly Payment

Whose Debt?

CONTINUE LISTING MORE DEBTORS HERE IF NEEDED

Have the applicants' payments been made on time?

Yes

Have the co-applicants' payments been made on time?

Yes

Are you currently in Chapter 13 bankruptcy?

Yes

Is the co-applicant currently in Chapter 13 bankruptcy?

Yes

If "yes", when did the Chapter 13 bankruptcy begin, when will it be paid off, and how much is the payment?

Have you had a Chapter 7 bankruptcy?

Yes

Has the co-applicant had a Chapter 7 bankruptcy?

Yes

If yes, when was the Chapter 7 bankruptcy discharged?

LIQUID FUNDS/SAVINGS/INVESTMENTS

Please list the approximate value of the following:

Checking Account (Applicant)

Checking Account (Co-Applicant)

Savings Account (Applicant)

Savings Account (Co-Applicant)

Cash (Applicant)

Cash (Co-Applicant)

CDs (Applicant)

CDs (Co-Applicant)

Securities (stocks, bonds, etc.) (Applicant)

Securities (stocks, bonds, etc.) (Co-Applicant)

Retirement account (Applicant)

Retirement account (Co-Applicant)

Are you about to receive additional funds (e.g., tax refunds, property sales, etc.)?

Yes

How much?

LIVING EXPENSES

Current monthly rent or mortgage (Applicant)

Current monthly rent or mortgage (Co-Applicant)

ADDITIONAL INFORMATION

Have you owned a home in the last three (3) years? (Applicant)

Yes

Have you owned a home in the last three (3) years? (Co-Applicant)

Yes

Do you have a contract on a house at this time? (Applicant)

Yes

Do you have a contract on a house at this time? (Co-Applicant)

Yes

Are you currently working with a real-estate agent? (Applicant)

Yes

Are you currently working with a real-estate agent? (Co-Applicant)

Yes

How Can We Reach You?

We would love to chat with you. How can we get in touch?

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

What's on your mind?

Please let us know what's on your mind. Have a question for us? Ask away.

Your Comments/Questions(Required)

AUTHORIZATION

Consent (Applicant). I authorize NeighborWorks® Boise to:(Required)

Pull my credit report (soft pull) to review my credit file for housing counseling in connection with my pursuit on a loan to purchase real property;

Pull my credit report and review my credit file for informational inquiry purposes; and/or

Not pull my credit, but continue with my HUD services for HUD counseling only.

Consent Name (Applicant)

Date (Applicant)

Consent (Co-Applicant). I authorize NeighborWorks® Boise to:

Pull my credit report (soft pull) to review my credit file for housing counseling in connection with my pursuit on a loan to purchase real property;

Pull my credit report and review my credit file for informational inquiry purposes; and/or

Not pull my credit, but continue with my HUD services for HUD counseling only.

Consent Name (Co-Applicant)

Date (Co-Applicant)

Counseling Intake Form

PERSONAL INFORMATION – APPLICANT

PERSONAL INFORMATION | CO-APPLICANT

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

APPLICANT EMPLOYMENT

SECONDARY EMPLOYER

CO-APPLICANT EMPLOYMENT

CO-APPLICANT SECONDARY EMPLOYMENT

APPLICANT INCOME

CO-APPLICANT INCOME

LIABILITIES/DEBT

LIQUID FUNDS/SAVINGS/INVESTMENTS

LIVING EXPENSES

ADDITIONAL INFORMATION

How Can We Reach You?

What's on your mind?

AUTHORIZATION

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