Advising Appointment Registration Form

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Page 1

To complete the intake process with the NeighborWorks Home Partners advising team, fill out the form below, continuing through all the pages.

The process should take between 5 and 8 minutes.
Provide the requested information for registration.
Review and sign our combined privacy policy and program disclosure.
Schedule your advising session.
The process will not be complete until you have completed all three steps.

If you have any questions, please call our office at 651-292-8710.

If you need this form in another language, choose from any of the options in the Google Translate menu below. Your browser must have JavaScript enabled.

Applicant

First Name

Middle Initial

Last Name

If you do not have an email address, please visit gmail.com/signup.

Phone

Enter with dashes. E.g. 123-456-7890

Phone Type

Opt in to receiving text messagesBy checking this box, you consent to receive text messages from us. The number you entered above must have the ability to accept text messages. Messaging and data rates may apply. Message frequency will vary. Once opted in, reply HELP to our messages for more information or STOP to opt out of messaging. See our Privacy Policy for more details on how we handle your information.

Best time to contact

Preferred Contact Type

Your Address

Begin typing your address. Continue until it appears in the lookup list, then select it.

Check for manual address entry if not found in the lookup.

Street Address

Apartment or Unit Number

City

Choose a State

State

Zip Code

Is there another adult in your household who should be included as a part of the advising services?

Co-applicant

First Name

Last Name

Co-applicant Email (Do not use the same email as used for the primary applicant)

Phone

Phone Type

Relationship to Primary Application

What type of advising are you interested in?

Hidden Fields

Service File ID

Counseling/Education ID

Owner ID

Owner Role/Agency formula

Contact ID

Agency ID

Agency Name

Disclosure URL

Self-Service

Current Month

Current Year

Last Year

Page 2

To demonstrate our commitment to equity and our service reach, we are required to collect demographic information from the clients we serve. Please answer the following demographic questions.

1. What is your birth date? (Enter in MM/DD/YYYY format)

2. Gender

What is your legal gender?

Gender Pronouns

i.e. She/Her/Hers; He/Him/His; They/Them/Theirs

What gender do you identify as?

3. What is the highest degree or level of education you have completed?

4. Are you a veteran?

4. Is your co-applicant a veteran?

5. Are you active military?

6. Are you living with a disability?

7. Do you need language assistance or an interpreter

8. What language do you primarily speak?

9. What is your current housing arrangement?

10. Do you live in a rural area?

11. What best describes your household type?

12. How many adults live with you?

13. How many children under the age of 18 live with you?

14. What is your current marital status?

15. What is your race?

15.1 What is the race of the other person you listed?

16. Are you Hispanic, Latino or Spanish origin?

16.1 Is the other person you listed of Hispanic, Latino or Spanish origin?

17. Were you born outside of the United States?

18. Do you identify with any of the following immigrant or new American communities?

19. Are you a first time home buyer (if you have not owned a home for the past 3 years, answer yes)?

20. Are you a first generation homebuyer (your parents did not own a home)?

How did you hear about us?

Subscribe to NWHP emails?

Yes, I would like to receive emails about NWHP news and programs.No, I opt out of receiving NWHP emails.

Page 3

Income

Do you have any sources of income?

YesNo

Primary Applicant Current Employment Status

Applicant Employment Income/Salary

Employer Name

Gross Annual Income

Please enter as a number

Start Date (enter in MM/DD/YYYY format)

Income Type

Occupation

Do you have income from any other sources other than salary (child support, alimony, social security)?

Additional Income

Income Type

Gross Annual Income

Please enter as a number

Co-applicant Current Employment Status

Co-applicant Employment Income/Salary

Co-applicant Employer Name

Co-applicant
Gross Annual Income

Please enter as a number

Co-applicant Start Date (enter in MM/DD/YYYY format

Co-applicant Income Type

Co-applicant Occupation

Does the co-applicant have income from any other sources other than salary (child support, alimony, social security)?

Additional Co-applicant Income

Co-applicant Additional Income Type

Co-applicant Additional Gross Annual Income

Please enter as a number

Additional Information

How much money do you have in savings that you could use towards a down payment?

Please enter as a number

Has a lender pre-approved you for a mortgage loan?

Have you signed a purchase agreement?

If yes, please provide the following details for the property you have agreed to purchase. If you don’t know leave blank.

Street Address

City

State

Zip Code

Purchase Price

Please enter as a number with no symbols

Loan Amount

Please enter as a number with no symbols.

Interest Rate

Close Date (enter in MM/DD/YYYY format)

Lender

When you click next on this page, your responses will be submitted and will no longer be editable.

You will be asked to review and sign our combined privacy policy and program disclosure. Please wait for it to appear.

There may be a short delay.

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