Homeowner Services Intake Packet

Have you received notice of a foreclosure sale date?

Yes
No

If yes, what is the sale date?

Enter date of foreclosure sale

Have you worked (past or present) with another agency for this issue?

Yes
No

If yes, what is the name of the agency you worked with?

When did you close on your home (date of Deed of Trust?)

What kind of loan do you have?

When was your last on-time mortgage payment?

MM/DD/YYYYY

Are you currently behind on your mortgage payments?

Yes
No

Applicant Name *

First

Middle

Last

Co-Applicant Name *

First

Middle

Last

LOAN SERVICER

Loan Servicer (to whom you make your payments)

Name of company

Name of Agent (if known)

Email of agent (if known)

Company Phone Number

Company Fax Number

APPLICANT INFORMATION

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Social Security Number

Birthdate

Home Phone Number

Cell Phone Number

Work Phone Number

Email

Gender

Race

Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Choose one

Education Level

Marital Status

Single
Married
Legally Separated

If married, date of marriage

If legally separated, do you have a legal separation agreement filed with the courts?

Yes
No

Employment

Name of Primary Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number of Employer

Hire Date

Title/Position

Yearly Gross Income (before taxes)

Full Time or Part Time

Full Time
Part Time

Choose one

Pay Frequency

Weekly
Every Two Weeks
Twice a month
Monthly

Co-Applicant Information

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Social Security Number

Birth date

Home Phone Number

Cell Phone Number

Work Phone Number

Email

Gender

Race

Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Choose one

Education Level

Marital Status (copy)

Single
Married
Legally Separated

If married, date of marriage

If legally separated, do you have a legal separation agreement filed with the courts?

Yes
No

Employment

Name of Primary Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number of Employer

Hire Date

Title/Position

Yearly Gross Income (before taxes)

Pay Frequency (copy)

Weekly
Every Two Weeks
Twice a month
Monthly

HOUSEHOLD INFORMATION

Total Household Size (include yourself in this number)

Total yearly income for all household members (before taxes)

Is there anyone else on the loan who is not living in the home?

Yes
No

Is there anyone else on the tile (the Deed of Trust) who is not living in the home?

Yes
No

Who lives in the home with you? (write down everyone, including yourself)

Name *

First

Last

Relationship

Age

Name

First

Last

Relationship

Age

Name

First

Last

Relationship

Age

Name

First

Last

Relationship

Age

Name

First

Last

Relationship

Age

Name

First

Last

Relationship

Age

OTHER HOUSEHOLD INCOME-MONTHLY INCOME BEFORE TAXES

Type of Income

Total All Jobs

Applicant

$

Co-Applicant

$

Alimony/Child Support

$

Disability

$

Self-Employment Income

$

Dependent SSI Income

$

Retirement/Pension Income

$

Unemployment

$

S

Public Assistance

$

Other income

$

If you receive child support payments, how long will support last?

Is the child support court ordered?

Yes
No

SAVINGS/INVESTMENTS

Please list approximate balances of all accounts you may have (multiple checking accounts, savings accounts, etc.)

Checking Account

Applicant

$

Co-Applicant

$

Savings Account

$

Cash

$

Other (stocks retirement, etc.)

$

Are you expecting to receive additional funds? (i.e. tax redufnds, settlemts, gift funds, property sales, inheritance etc.)

Yes
No

If yes, what is the amount of these funds?

$

What is the source of these funds?

PROPERTY INFORMATION

What was the purchase price of your home?

The property is

Primary residence
Investment property
Other

Type of Property

Mortgage Information

Loan number

Current loan balance

Current interest rate

My interest rate is

Fixed
Adjustable
Other

Does your monthly mortgage payment include homeowners insurance?

Yes
No

Does your monthly mortgage payment include property taxes?

Yes
No

Have you ever refinanced your mortgage?

Yes
No

If yes, how many times?

When was the last time?

ADDITIONAL QUESTIONS

Do you wish to stay in your home?

Yes
No

How did you hear about us?

What caused your current situation?

What steps (if any) have you taken to improve your financial situation?

Is there anything we should now that is NOT mentioned in this intake packet (current or future living situation, loan status, household income, household members, etc.)?

Applicant - Are you CURRENTLY in Chapter 13 Bankruptcy?

Yes
No

Co-Applicant - Are you CURRENTLY in Chapter 13 Bankruptcy?

Yes
No

If yes, when did it begin?

When will it be discharged?

How much is the payment?

Applicant - Have you HAD a Chapter 13 Bankruptcy in the past 10 years?

Yes
No

Co-Applicant - Have you HAD a Chapter 13 Bankruptcy in the past 10 years?

Yes
No

If yes, when was it discharged?

Applicant - Have you HAD a Chapter 7 Bankruptcy in the past 10 years?

Yes
No

Co-Applicant - Have you HAD a Chapter 7 Bankruptcy in the past 10 years?

Yes
No

If yes, when was it discharged?

Applicant- Have you legally changed your name since you last purchased or refinanced your home?

Yes
No

Co-Applicant- Have you legally changed your name since you last purchased or refinanced your home?

Yes
No

Applicant- Do you currently receive a Section 8 Housing Choice Voucher?

Yes
No

Co-Applicant- Do you currently receive a Section 8 Housing Choice Voucher?

Yes
No

If yes, how much per month?

$

If yes, how much per month?

$

Applicant- Are you a veteran?

Yes
No

Co-Applicant- Are you a veteran?

Yes
No

Applicant- Are you disabled?

Yes
No

Co-Applicant- Are you disabled?

Yes
No

Applicant- Were you born in the United States of America?

Yes
No

Co-Applicant- Were you born in the United States of America?

Yes
No

Applicant- if no, are you a permanent resident or DACA recipient?

Yes
No

Co-Applicant- if no, are you a permanent resident or DACA recipient?

Yes
No

ADDITIONAL EMPLOYMENT

Additional employment of:

Applicant
Co - Applicant

Please choose one

Name of Employer

Address of Employer

Address Line 1

City

State

Zip Code

Phone number of employer?

Hire Date

Your Job Title / Position

Yearly Gross Income (before taxes)

$

Is this a full time job or a part time job?

Full Time
Part Time

choose one

What is your pay frequency?

Weekly
Every Two Weeks
Twice a month
Monthly

Additional employment of: (copy)

Applicant
Co - Applicant

Please choose one

Name of Employer (copy)

Address of Employer (copy) (copy)

Address Line 1

City

State

Zip Code

Phone number of employer? (copy)

Hire Date (copy)

Your Job Title / Position (copy)

Yearly Gross Income (before taxes) (copy)

$

Is this a full time job or a part time job? (copy)

Full Time
Part Time

choose one

What is your pay frequency? (copy)

Weekly
Every Two Weeks
Twice a month
Monthly

Additional employment of: (copy) (copy)

Applicant
Co - Applicant

Please choose one

Name of Employer (copy) (copy)

Address of Employer (copy)

Address Line 1

City

State

Zip Code

Phone number of employer? (copy) (copy)

Hire Date (copy) (copy)

Your Job Title / Position (copy) (copy)

Yearly Gross Income (before taxes) (copy) (copy)

$

Is this a full time job or a part time job? (copy) (copy)

Full Time
Part Time

choose one

What is your pay frequency? (copy) (copy)

Weekly
Every Two Weeks
Twice a month
Monthly

INTAKE FORM VERIFICATION - APPLICANT

By signing below, I acknowledge the following terms: · I understand that this form will be used in conjunction with other documents and information in order to determine my eligibility for down payment/closing cost assistance. · I agree that this form has been filled out truthfully and accurately to the best of my knowledge and ability. If anything on this form should change, I agree to contact The Housing Partnership, Inc. (THP) as soon as possible to correct the information. · I acknowledge that if pertinent details change on this form and I do not notify THP in a timely manner, it may risk my eligibility for down payment/closing cost assistance.

Clear Signature

Applicant signature and date

INTAKE FORM VERIFICATION - CO-APPLICANT

By signing below, I acknowledge the following terms: · I understand that this form will be used in conjunction with other documents and information in order to determine my eligibility for down payment/closing cost assistance. · I agree that this form has been filled out truthfully and accurately to the best of my knowledge and ability. If anything on this form should change, I agree to contact The Housing Partnership, Inc. (THP) as soon as possible to correct the information. · I acknowledge that if pertinent details change on this form and I do not notify THP in a timely manner, it may risk my eligibility for down payment/closing cost assistance.

Clear Signature

Co-Applicant signature and date

CREDIT AUTHORIZATION - APPLICANT

By signing below, I acknowledge the following terms: · I authorize The Housing Partnership, Inc. (THP) to obtain my credit report(s) from my lender and review said credit report(s) for housing counseling, in connection with my pursuit of a loan to purchase real property. · If THP is unable to obtain said credit report(s), I authorize them to pull my credit report(s). · I understand that if THP needs to pull my credit report(s), there will be a fee of $17.98 for individual applicants or $35.96 for two applicants that I must pay per direction by THP. · I understand that this credit pull from THP would be a soft inquiry and would not impact my scores or report(s).

Clear Signature

Applicant signature and date

CREDIT AUTHORIZATION - CO-APPLICANT

By signing below, I acknowledge the following terms: · I authorize The Housing Partnership, Inc. (THP) to obtain my credit report(s) from my lender and review said credit report(s) for housing counseling, in connection with my pursuit of a loan to purchase real property. · If THP is unable to obtain said credit report(s), I authorize them to pull my credit report(s). · I understand that if THP needs to pull my credit report(s), there will be a fee of $17.98 for individual applicants or $35.96 for two applicants that I must pay per direction by THP. · I understand that this credit pull from THP would be a soft inquiry and would not impact my scores or report(s).

Clear Signature

Co-Applicant signature and date

CLIENT/COUNSELOR AGREEMENT

Client/Counselor Agreement The Housing Partnership, Inc. (THP) and its counselors agree to provide the following services: 1. Analysis of any mortgage default, including the amount and cause of the default 2. Explanation of default and/or foreclosure process 3. Discussion of reasonable options available to the homeowner 4. Assistance communicating with the mortgage loan servicer and other creditors 5. Development an action plan and tracking of timely completion of promised action 6. Identification of assistance resources 7. Referrals to needed resources 8. Confidentiality, honesty, respect, and professionalism in all services. I agree to the following terms of service: 1. I will provide honest and complete information to my counselor(s), whether verbally or in writing 2. I will provide all necessary documentation and follow-up information in the form and timeframe requested 3. I will be on time for appointments and understand that if I am late for an appointment, the appointment will still end at the scheduled time or will be rescheduled 4. I will give the counselor(s) appropriate notice if I am unable to attend an appointment 5. I will complete the action plans as agreed upon (and modified as deemed appropriate) to the best of my ability 6. I will contact the counselor(s) about any changes in my situation immediately 7. I understand that breaking this agreement may cause THP to cease to provide its services to me.

Clear Signature

Applicant signature and date

Client/Counselor Agreement The Housing Partnership, Inc. (THP) and its counselors agree to provide the following services: 1. Analysis of any mortgage default, including the amount and cause of the default 2. Explanation of default and/or foreclosure process 3. Discussion of reasonable options available to the homeowner 4. Assistance communicating with the mortgage loan servicer and other creditors 5. Development an action plan and tracking of timely completion of promised action 6. Identification of assistance resources 7. Referrals to needed resources 8. Confidentiality, honesty, respect, and professionalism in all services I agree to the following terms of service: 1. I will provide honest and complete information to my counselor(s), whether verbally or in writing 2. I will provide all necessary documentation and follow-up information in the form and timeframe requested 3. I will be on time for appointments and understand that if I am late for an appointment, the appointment will still end at the scheduled time or will be rescheduled 4. I will give the counselor(s) appropriate notice if I am unable to attend an appointment 5. I will complete the action plans as agreed upon (and modified as deemed appropriate) to the best of my ability 6. I will contact the counselor(s) about any changes in my situation immediately 7. I understand that breaking this agreement may cause THP to cease to provide its services to me.

Clear Signature

Co-Applicant signature and date

CONFLICT OF INTEREST

The Housing Partnership, Inc. (THP) is a nonprofit organization that is in business to provide home repair services, homebuyers and renters training and counseling (credit and budget), affordable housing development including both for-rent and for-sale properties, and mortgage assistance. As a provider of multiple services there is a possibility of conflict of interest for the prospective clients, particularly those seeking training and counseling services. Since you are or will be receiving training and counseling designed for homebuyers, homeowners, or renters, THP staff want to be clear that you understand that you: 1. Are under no obligation to obtain a loan or grant for home repair, down payment and closing cost assistance, or home purchase from THP or any individual or company they may refer you to; and 2. Are under no obligation to utilize the services of any person or company they may refer you to for real estate, inspection, construction, home repairs, loans and other services or forms of assistance. Personal information provided to us as part of the services will not be shared with another party without your expressed written consent.

Clear Signature

Applicant signature and date

The Housing Partnership, Inc. (THP) is a nonprofit organization that is in business to provide home repair services, homebuyers and renters training and counseling (credit and budget), affordable housing development including both for-rent and for-sale properties, and mortgage assistance. As a provider of multiple services there is a possibility of conflict of interest for the prospective clients, particularly those seeking training and counseling services. Since you are or will be receiving training and counseling designed for homebuyers, homeowners, or renters, THP staff want to be clear that you understand that you: 1. Are under no obligation to obtain a loan or grant for home repair, down payment and closing cost assistance, or home purchase from THP or any individual or company they may refer you to; and 2. Are under no obligation to utilize the services of any person or company they may refer you to for real estate, inspection, construction, home repairs, loans and other services or forms of assistance. Personal information provided to us as part of the services will not be shared with another party without your expressed written consent.

Clear Signature

Co-Applicant signature and date

PRIVACY POLICY AND PRACTICES

We at The Housing Partnership, Inc. (THP) 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. Information We Collect We collect personal information to support our housing counseling program and to aid you in qualifying for special funding for potential mortgage assistance. We may collect personal information about you from the · Applications or other forms that we receive from you; Correspondence about your transactions with us, our affiliates, or others; Credit reports from a consumer reporting agency; and · 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 your 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 reports, credit history, and creditworthiness To Whom Do We Disclose We may disclose personal information about you to third parties as permitted by law. These third parties may include government and nonprofit organizations involved in community development, where your personal information would only be shared for program review, auditing, research, and oversight purposes. These third parties may also include other entities that may be involved in the efforts to assist with loan modification, foreclosure intervention, or other post-purchase services. By signing below, you acknowledge and accept the collection and disclosure of personal information as described in this form.

Clear Signature

Applicant signature and date

We at The Housing Partnership, Inc. (THP) 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. Information We Collect We collect personal information to support our housing counseling program and to aid you in qualifying for special funding for potential mortgage assistance. We may collect personal information about you from the · Applications or other forms that we receive from you; · Correspondence about your transactions with us, our affiliates, or others; · Credit reports from a consumer reporting agency; and · 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 your 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 reports, credit history, and creditworthiness To Whom Do We Disclose We may disclose personal information about you to third parties as permitted by law. These third parties may include government and nonprofit organizations involved in community development, where your personal information would only be shared for program review, auditing, research, and oversight purposes. These third parties may also include other entities that may be involved in the efforts to assist with loan modification, foreclosure intervention, or other post-purchase services. By signing below, you acknowledge and accept the collection and disclosure of personal information as described in this form.

Clear Signature

Co-Applicant signature and date

THIRD PARTY AUTHORIZATION

I authorize The Housing Partnership, Inc. to: Request and/or release any documentation that I have provided to any third party that is directly involved in this transaction and is necessary to assist me with mortgage payment assistance, loan modification, foreclosure intervention, or other post-purchase services.

Clear Signature

Applicant signature and date

I authorize The Housing Partnership, Inc. to: Request and/or release any documentation that I have provided to any third party that is directly involved in this transaction and is necessary to assist me with mortgage payment assistance, loan modification, foreclosure intervention, or other post-purchase services.

Clear Signature

Co-Applicant signature and date

AUTHORIZATION TO RELEASE INFORMATION

Applicant Name *

First

Middle

Last

Property Address

Address Line 1

City

State

Zip Code

First Loan Number

Second Loan Number

Applicant Social Security Number

I understand that my mortgage servicer and/or HUD may refer me to an independent counseling organization to help me with my financial obligations. For this purpose, I hereby authorize the servicer to release certain financial information, related to my mortgage loan, to The Housing Partnership, Inc. (THP), P.O. Box 16356, 729 Lemay Ferry Rd, St. Louis, MO 63125. All information released to THP will remain strictly confidential. This information will include but is not limited to: Original Loan Amount Current Balance Amount Past Due/Date of Last Payment Payment History Monthly Payment Amount Loss Mitigation/Modification Agreement Escrow statement Payment Due Date I further hereby authorize THP to furnish any information regarding my financial status which may assist the servicer or its affiliates in determining whether my homeownership may be preserved by restructuring my loan or by other services. I also authorize THP to receive copies of documents pertaining to my financial information including but not limited to: Forbearance Agreement, Modification, Partial Claim, Reinstatement Figures, and Payoff Statements. I may be referred to other housing services of THP or another agency or agencies, as appropriate, that may be able to assist me with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.

Clear Signature

Applicant signature and date

Co-Applicant Name

First

Middle

Last

Property Address

Address Line 1

City

State

Zip Code

First Loan Number

Second Loan Number

Co-Applicant Social Security Number

I understand that my mortgage servicer and/or HUD may refer me to an independent counseling organization to help me with my financial obligations. For this purpose, I hereby authorize the servicer to release certain financial information, related to my mortgage loan, to The Housing Partnership, Inc. (THP), P.O. Box 16356, 729 Lemay Ferry Rd, St. Louis, MO 63125. All information released to THP will remain strictly confidential. This information will include but is not limited to: Original Loan Amount Current Balance Amount Past Due/Date of Last Payment Payment History Monthly Payment Amount Loss Mitigation/Modification Agreement Escrow statement Payment Due Date I further hereby authorize THP to furnish any information regarding my financial status which may assist the servicer or its affiliates in determining whether my homeownership may be preserved by restructuring my loan or by other services. I also authorize THP to receive copies of documents pertaining to my financial information including but not limited to: Forbearance Agreement, Modification, Partial Claim, Reinstatement Figures, and Payoff Statements. I may be referred to other housing services of THP or another agency or agencies, as appropriate, that may be able to assist me with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.

Clear Signature

Co-Applicant signature and date

Comment or Message

LOAN SERVICER

APPLICANT INFORMATION

Employment

Co-Applicant Information

Employment

HOUSEHOLD INFORMATION

Who lives in the home with you? (write down everyone, including yourself)

OTHER HOUSEHOLD INCOME-MONTHLY INCOME BEFORE TAXES

SAVINGS/INVESTMENTS

PROPERTY INFORMATION

Mortgage Information

ADDITIONAL QUESTIONS

ADDITIONAL EMPLOYMENT

INTAKE FORM VERIFICATION - APPLICANT

INTAKE FORM VERIFICATION - CO-APPLICANT

CREDIT AUTHORIZATION - APPLICANT

CREDIT AUTHORIZATION - CO-APPLICANT

CLIENT/COUNSELOR AGREEMENT

CONFLICT OF INTEREST

PRIVACY POLICY AND PRACTICES

THIRD PARTY AUTHORIZATION

AUTHORIZATION TO RELEASE INFORMATION

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