ࡱ>  2Wbjbj 8No4 668%Ah:::tttS S S @@@@@@@$C?F,@S |S S S @66ttc@A'A'A'S v68tt@A'S @A'A'6L8Xn:tjb9 9@@0%A9kG"kG8::xkG,<dS S A'S S S S S @@%,S S S %AS S S S kGS S S S S S S S S : NEIGHBORHOOD HOUSING & DEVELOPMENT CORPORATION 633 NW 8TH AVE. GAINESVILLE, FL 32601 TELEPHONE (352)380-9119 FAX (352)380-9170 WWW.GNHDC.ORG Dear Prospective Homeowner: Thank you for considering Neighborhood Housing & Development Corporation to help make your dream of homeownership a reality. Please complete the steps below so that we may process your intake packet for pre-purchase counseling. Complete the entire intake form. Make sure it is signed and dated. If there is a co-applicant, make sure that all of their information is provided and they have signed, as well. Make copies of all pertinent documents listed on the Document list (page 2). If needed, you may bring them into the office and we can make copies for you. If you are receiving income from Social Security, Retirement, SSI, Child Support, Disability, Rental, etc., please provide documentation. Include a letter of explanation for any gap of employment and any adverse credit issues. Drop off, mail, email (aconklin@gnhdc.org) or fax in your completed intake packet and required documents. Attention: Anne Conklin Once your completed intake packet and pertinent documents have been received and reviewed, we will contact you to schedule an appointment. Sincerely, NHDC Housing Advisors 5/2019 NHDC Document list: Proof of monthly income - paycheck stubs, etc. for all applicant(s). Two most recent checking and savings account monthly statements (An online transaction history, is NOT acceptable). Drivers License or picture ID of applicant(s). Social Security Card of applicant(s) presented at time of paperwork submission for verification (copy is not needed) Letter of explanation for any gap of employment during the last two years, also include any explanation of negative credit on your credit report. Divorce paper, if child support or alimony is court ordered.  NEIGHBORHOOD HOUSING & DEVELOPMENT CORPORATION 633 NW 8th AVE. GAINESVILLE, FL 32601 TEL: (352)380-9119 FAX: (352)380-9170 PERSONAL PROFILE INTAKE FORM CUSTOMER Please Print Clearly Name: ________________________________________________________________________________________ Last MI First PHYSICAL ADDRESS ______________________________________________________________________________________________ Street ______________________________________________________________________________________________ City State Zip Code County MAILING ADDRESS (if different from physical address) _______________________________________________________________________________________________ Street _______________________________________________________________________________________________ City State Zip Code Home: (_____) ___________________ Work: (______) ___________________ Email: _________________________ _______________________ ______/______/________ ____________ Social Security Number Birth Date (MM/DD/YYYY) No. of years at current address Credit Score (if known): ________________ Repository (Circle corresponding): Experian TransUnion Equifax Gender (please circle one): Female Male Marital Status (please circle one): Single Married Divorced Separated Widowed Race (please circle all that apply): 1.Black or African American 3. Asian 5. White 2. Native Hawaiian/Other Pacific Islander 4. American Indian/Alaskan Native 6. Other___________________ Ethnicity (please select yes or no for Hispanic Origin. You should select both a Race category and a yes or no for Hispanic origin: Hispanic: Yes No Language spoken in the home (if not English): ___________________ Disabled? Yes No Veteran? Yes No Active Military? Yes No First Time Homebuyer-not owned a home within the last 3 years? Yes No Gross Annual Family or Household Income (Before taxes): $___________________ Current Housing Arrangement: 1. Rent 2. Homeowner with mortgage 3. Living with family member and not paying rent 4. Homeowner with mortgage paid off Household Type (please select the most accurate)? 1. Female headed single parent household 2. Male headed single parent household 3. Single adult 4. Two or more unrelated adults 5. Married with children 6. Married without children 7. Other Family/Household Size:______ How many dependents (other than those listed by any co-borrower)? What ages are they? ____,____,____,____,____,____,____,____,____ Are there non-dependents who will be living in the home? Yes No If yes, list below: Relationship Age Relationship Age Education (please circle one): 1. Below High School Diploma 2. High School Diploma or Equivalent 3. College Referred to by (please circle all that apply): Print Advertisement Bank Government TV Realtor Staff/Board member Walk-In Friend Radio Newspaper Article If you were referred by a bank, which one? If referred by another source not listed above, which one? CUSTOMER EMPLOYMENT Last 2 Years Please Print Clearly Primary Employer: _________________________________________________ Title Hire Date Street City State Zip Code Phone: (_______) ____________________ Part Time or Full Time (Please circle one) Years in Profession: Gross Income (before taxes): $____________________ Is this amount paid ___hourly ___weekly ___every two weeks ___twice a month ___monthly? Previous Employer: _________________________________________________ Title Length of Employment Street City State Zip Code Phone: (_______) ____________________ Part Time or Full Time (Please circle one) Years in Profession: Gross Income (before taxes): $____________________ Is this amount paid ___hourly ___weekly ___every two weeks ___twice a month ___monthly? Continue listing previous employers on a separate sheet of paper. Secondary Employer: _________________________________________________ Title Hire Date Street City State Zip Code Phone: (_______) _______________________ Part-Time or Full-Time (Please Circle one) Gross Income (before taxes): $____________________ Is this amount paid ___hourly ___weekly ___every two weeks ___twice a month ___monthly? CO-APPLICANT Name: Last MI First Street City Zip Code County Home: (_____) ___________________ Work: (______) ___________________Email: _________________________ _____________________ ______/______/______ Social Security Number Birth Date Gender (please circle one): Female Male Marital Status (please circle one): Single Married Divorced Separated Widowed Race (please circle all that apply): 1.Black or African American 3. Asian 5. White 2. Native Hawaiian/Other Pacific Islander 4. American Indian/Alaskan Native 6. Other___________________ Ethnicity (please select yes or no for Hispanic Origin. You should select both a Race category and a yes or no for Hispanic origin: Hispanic: Yes No Language spoken in the home (if not English): ___________________ Disabled? Yes No Veteran? Yes No Active Military? Yes No First Time Homebuyer-not owned a home within the last 3 years? Yes No Education (please circle one): 1. Below High School Diploma 2. High School Diploma or Equivalent 3. College Relationship to Customer (please circle): Spouse Daughter Son Sister Brother Girlfriend Boyfriend Mother Father Domestic Partner Other: CO-APPLICANT EMPLOYMENT Last 2 Years Primary Employer: _________________________________________________ Title Hire Date Street City State Zip Code Phone: (_______) ____________________ Part Time or Full Time (Please circle one) Years in Profession: Gross Income (before taxes): $____________________ Is this amount paid ___hourly ___weekly ___every two weeks ___twice a month ___monthly? Previous Employer: _________________________________________________ Title Length of Employment Street City State Zip Code Phone: (_______) _______________________ Part-Time or Full-Time (Please Circle One) Continue listing previous employers on a separate sheet of paper. Secondary Employer: _________________________________________________ Title Hire Date Street City State Zip Code Phone: (_______) ____________________ Part Time or Full Time (Please circle one) Years in Profession: Gross Income (before taxes): $____________________ Is this amount paid ___hourly ___weekly ___every two weeks ___twice a month ___monthly? INCOME Please Print Clearly CUSTOMER CO-APPLICANT Type of Income Monthly Amount Monthly Amount Salary Alimony/Child Support Rental Income Social Security Pension Income Public Assistance Self-employment Income Dependent SSI Income Disability Income Other Employment CUSTOMER CO-APPLICANT Can you document your child support/alimony income? Yes No Yes No 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 No Yes No Regarding other employment, have you worked in this field for two years or more? Yes No Yes No LIABILITIES/DEBT Please list any debts you have, including credit cards, auto loans, and student loan. Do NOT include rent or utilities. Current Monthly Whos Debt? Paid To (Bank name, Credit Card Company, etc.) Balance Payment C=Customer, A=Co-Applicant B=Both 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Please use additional sheets if necessary. CUSTOMER CO-APPLICANT Have your payments been made on time? Yes No Yes No Are you currently in Chapter 13 bankruptcy? Yes No Yes No If yes, when did it begin? _____________ If yes, when will it be paid out? _____________ If yes, how much is the payment? _____________ Have you had a Chapter 7 bankruptcy? Yes No Yes No If yes, when was it discharged? _____________ If yes, how much? $____________________ MONTHLY BUDGET ANALYSIS Essential ExpensesTotal Household Monthly AmountHousingRentPhoneCellular PhoneWater/SewerElectric/GasTrash/SewerCable TV/ Satellite/InternetSubtotalLiving ExpensesGroceries/Household ItemsFood at work/SchoolClothing: New/Dry CleaningTransportation (Gas/ Bus)Insurance (Auto, Medical, Life, etc.)PrescriptionsCredit Card(s)Personal LoansStudent LoansAlimony/ Child SupportCar LoanMedical BillsChild CareSubtotalOther (Specify)Other:Other:Other:SubtotalTotal Expenses AssetsTotal Household Monthly AmountChecking account(s)Savings account(s)CashCDsRetirement account401K/ 403BStocks and BondsMoney Market account(s)Other Liquid FundsTotal Net IncomeTotal Household Monthly AmountEmploymentSSI DisabilityChild Support/ AlimonyPension IncomePublic AssistanceSelf-employment IncomeDisability IncomeOther EmploymentTotal ADDITIONAL INFORMATION CUSTOMER CO-APPLICANT Do you have a contract on a house at this time? Yes No Yes No Are you currently working with a real-estate agent? Yes No Yes No AUTHORIZATION I authorize NHDC HomeOwnership Center to: pull my/our credit report to review my/our credit file for housing counseling in connection with my pursuit on a loan to purchase real property; pull my/our credit report and review my/our credit file for informational inquiry purposes; and obtain a copy of the HUD-1 Settlement Statement (Closing Disclosure), Appraisal, and Real Estate Note(s) when I purchase a home, from the lender who made me/us a loan and/or the title company that closed the loan. I/We understand that any intentional or negligent representation(s) of the information contained on this form may result in civil liability and/or criminal liability under the provisions of Title 18, United States Code, Section 1001. _________________________________________________________ ____________________ Customer Date _________________________________________________________ ____________________ Co-Applicant Date NHDC Fee Schedule As of May 1, 2019 1. Home Buyer Education Seminar $50 The Home Buyer Education (HBE) Seminar is 8 hours of instruction that focuses on the home purchase process. Clients graduating from the class may be eligible for City, County, or State of Florida subsidy assistance or special financing offered by the mortgage lender. 2. Pre-Purchase Counseling - Credit Report- $25.00 per person Pre-Purchase Counseling is a one on one counseling session that focuses on helping you to reach your goal of homeownership, car purchase, etc. and budgeting management. A soft pull credit report is required. 3. Mortgage Delinquency/Foreclosure Intervention Counseling No fee charged; however, a credit report is required 4. Financial Fitness Program No charge The Financial Fitness program focus is on budgeting, credit education and other financial topics. It is intended for clients who have an interest in becoming a home owner but need to resolve some issues keeping them form securing a mortgage. Acknowledgement of Fee Schedule I have read this schedule and I am aware of the fees. I am responsible to pay for only those services specifically requested. I am not obligated to receive nor pay for any other services that may be offered by NHDC or its partners. ______________________________________________ _______________ Signature Date PRIVACY POLICY AND PRACTICES OF Neighborhood Housing and Development Corporation Homeownership Center We at Neighborhood Housing and Development Corporation Homeownership Center (NHDCHC) value your trust and are committed to the responsible management, use and protection of personal information. This notice describes our policy regarding the collection and disclosure of personal information. Personal information, as used in this notice, means information that identifies an individual personally and is not otherwise publicly available information. It includes personal financial information such as credit history, income, employment history, financial assets, bank account information and financial debts. It also includes your social security number and other information that you have provided us on any applications or forms that you have completed. Information We Collect We collect personal information to support our lending operations, financial fitness counseling, and to aid you in shopping for a home mortgage from a conventional lender. In addition, we collect personal information to assist you with resolving mortgage delinquency. We collect personal information about you from the following sources: Information that we receive from you on applications or other forms, Information about your transactions with us, our affiliates or others, Information we receive from a consumer reporting agency, and Information that we receive from personal and employment references. Information We Disclose We may disclose the following kinds of personal information about you: Information we receive from you on applications or other forms, such as your name, address, social security number, employer, occupation, assets, debts and income; Information about our transactions with us, our affiliates or others, such as your account balance, payment history and parties to your transactions; and Information we receive from a consumer reporting agency, such as your credit bureau reports, your credit history and your creditworthiness. To Whom Do We Disclose We may disclose your personal information to the following types of unaffiliated third parties: Financial service providers, such as companies engaged in providing home mortgage or home equity loans, Others, such as nonprofit organizations involved in community development, but only for program review, auditing, research and oversight purposes. We may also disclose personal information about you to third parties as permitted by law. Prior to sharing personal information with unaffiliated third parties, except as described in this policy, we will give you an opportunity to direct that such information not be disclosed. Confidentiality and Security We restrict access to personal information about you to those of our employees who need to know that information to provide products and services to you and to help them do their jobs, including underwriting and servicing of loans, making loan decisions, aiding you in obtaining loans from others, and financial counseling. We maintain physical and electronic security procedures to safeguard the confidentiality and integrity of personal information in our possession and to guard against unauthorized access. We use locked files, user authentication and detection software to protect your information. Our safeguard complies with federal regulations to guard your personal information. Initial ____________________________ Directing Us Not to Make Disclosures to Unaffiliated Third Parties If you prefer that we not disclose personal information about you to unaffiliated third parties, you may opt out of those disclosures, that is, you may direct us not to make those disclosures (other than disclosures permitted by law). If you wish to opt out of disclosures to unaffiliated third parties other than nonprofit organizations involved in community development, you may check Box 1 on the attached Privacy Choices Form. If you wish to opt out of disclosures to nonprofit organizations involved in community development that are used only for program review, auditing, research and oversight purposes, you may check Box 2 on the attached Privacy Choices Form. Please allow approximately 30 days from our receipt of your Privacy Choices Form for it to become effective. Your privacy instructions and any previous privacy instructions will remain in effect until you request a change. PRIVACY CHOICES FORM If you want to opt out, that is direct us not to make disclosures about your personal information (other than disclosures permitted by law) as described in this notice, check the box or boxes below to indicate your privacy choices. Then send this form to the address listed below. Box 1 Limit disclosure of personal information about me to unaffiliated third parties other than nonprofit organizations involved in community development.  Box 2 Limit disclosure of personal information about me to nonprofit organizations involved in community development that are used only for program review, auditing, research and oversight purposes.  Name: Address: City: State: ________ Zip Code: Phone Number: If you have checked any of the boxes above, Please mail this form in a stamped envelope to: Neighborhood Housing and Development Corporation Homeownership Center 633 NW 8th Avenue Gainesville, Florida 32601 Please allow approximately 30 days from our receipt of your Privacy Choices Form for it to become effective. Your privacy instructions and any previous privacy instructions will remain in effect until you request a change.     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