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Credit Authorization Pre-Qualification Form

CREDIT AUTHORIZATION & PRE-QUALIFICATION FORM

Date MM/DD/YYYY
Mode of Counseling
PersonPhone
Referral Source: How did you year about the program:
Friend/RelativeInternetGov't AgencyLenderCommunity EventChurchMailingRadioSocial MediaBillboardMail AdReal Estate Agent

APPLICANT

Gender
MaleFemale
Occupancy
OwnRentOther
Residency Status
U.S CitizenPermanent Resident Alien
Veteran?
YesNo
Disabled?
YesNo
Household Type:
Single AdultMarried w/ DependentsMarried w/o DependentsFemale-Headed of Single Parent HouseholdMale-Headed of Single Parent HouseholdTwo or more Related AdultsOther

CO-APPLICANT

Co-BorroweSpouseContributor
Address
Check if same Address
Gender
MaleFemale
Occupancy
OwnRentOther
Residency Status
U.S CitizenPermanent Resident Alien
Veteran?
YesNo
Disabled?
YesNo

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Credit Authorization & Pre-qualification Form
1)I/We understand that Neighborhood Housing Services of Los Angeles County (NHS) and it partners provides home maintenance counseling after which I will receive an action plan consisting of recommendations for handling my finances, possibly including referrals to other agencies as appropriate.

2) I/We acknowledge that I have received a copy of NHS' Privacy Policy.

3) I/We understand that Neighborhood Housing Services of Los Angeles County receives funds through various funders and grant administrators and,as such, I authorize NHS, if required by the program guidelines to

(a) submit client-level information to the program for this grant,

(b) allow my file to be reviewed for program monitoring and compliance purposes, and

(c) conduct follow-up with me related to program evaluation.


Check here to opt out of provision for funders or grant administrators to follow-up with related program evaluation.

4.I/We may be referred to other housing services of the organization or another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.

5. A counselor may answer questions and provide information, but not give legal advice. If I want legal advice, I will be referred for appropriate assistance.

6) I/We authorize NHS or its partners to pull my/our credit report(s)as part of the counseling to be received.

7) The counseling services, lending products,affordable housing and other forms of assistance that may be offered by Neighborhood Housing Services of Los Angeles County,its' affiliates, directors, officers, employees or agents may also be offered by other providers.I understand that I am under no obligation to accept affiliate services.

Borrower Signature
Co-Borrower Signature
Date: MM/DD/YYYY
Date: MM/DD/YYYY

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Monthly Budget

INCOME

Sources of Income: Wages, Self-Employed, Social Security, Pension, Disability, Public Assistance, Rental, Child Support, etc.
Applicant
Source
Frequency
Monthly Gross
Monthly Net

WeeklyEvery 2 weeks2 x a MonthMonthly

WeeklyEvery 2 weeks2 x a MonthMonthly

WeeklyEvery 2 weeks2 x a MonthMonthly

WeeklyEvery 2 weeks2 x a MonthMonthly

WeeklyEvery 2 weeks2 x a MonthMonthly

TOTAL INCOME
AVERAGE MONTHLY EXPENSES
Rent / Mortgage $
Rental Insurance
Car Payment
Car Insurance
Credit Cards(minimum payment)
Installment Loans
Student Loans
Groceries
Eating Out
Gas / Transportation
Water
Electric
Gas
Phone Cell
Cable / Internet
Entertainment
Child Care / Tuition
Medical
Contributions
Other

ASSETS

LIQUID ASSETS

Checking
Checking
Saving
TOTAL LIQUID ASSETS

HARD ASSETS

Stocks / Bonds / CD's
401(k) / Retirement
Other
TOTAL HARD ASSETS
Signature
Signature

Program Eligibility Questionnaire

Buyer Eligibility Questionnaire

1) Are you a U.S. Citizen?

YesNo
2)Are you a permanent resident alien?

YesNo
3)Do you own another property?

YesNo
4)Have you co-signed with anyone on another property?

YesNo
If yes, explain

5)List all Members of the Household:





















Documents needed for eligibility & pre-approval review:

6) Two current paycheck stubs for all Household Members 18 years or older

Information obtained is for preliminary evaluation only, and does not constitute a commitment to sell or lend. All information is subject to verification.
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Borrower Signature

Date

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Co-Borrower Signature

Date