Family/Friend â. Counseling agencyâ ... __________Do you receive a rent subsidy or rent stipend? YES â .... homeow
April 21, 2018 Bronx, NY
April 21, 2018 Bronx, NY How did you hear about this event: HDF Invitation ☐ HDF Website☐ Loan Officer☐ Realtor☐ Family/Friend ☐
APPLICANT CONTACT & HOUSING INFORMATION Last Name First Name
Counseling agency☐
Other☐
Today’s Date
MI
Street Address
Apartment/Unit #
City
State
ZIP
Phone
E-mail Address DO YOU PAY RENT? NO ☐ I live with family/friends ☐ Other ☐ YES ☐ Monthly Cost $_________________ How long have you lived in this unit? __________Do you receive a rent subsidy or rent stipend? YES ☐ ______________________ NO ☐ WOULD YOU CONSIDER YOUR HOME TO BE IN AN URBAN AREA ☐ OR A RURAL AREA ☐ BIRTH DATE:
AGE:
FIRST TIME HOME BUYER? YES ☐ NO ☐
GENDER:
Active Military? YES ☐ NO ☐ Please answer both: Race: White☐ Black☐ Asian☐ Native Hawaiian☐American Indian☐ Multi-race☐ Ethnicity: Not Hispanic ☐ Hispanic ☐ Veteran? YES ☐ NO ☐ Are you a citizen of the United States? If not, do you have a Green Card? Preferred Language: ENGLISH ☐ YES ☐ NO ☐ YES ☐ NO ☐ SPANISH ☐ PORTUGUESE ☐CREOLE ☐ Country of Origin: ________________ OTHER ☐ ________________ HOUSEHOLD INFORMATION Are you: single ☐ married ☐ divorced ☐ separated ☐ widowed ☐ Total # of people in your household __________________ # of Children under 18 years old________ Choose best household description: Single Adult (over 18) ☐ 2 or more related adults ☐ Female-headed single parent household ☐ Male-headed single parent household ☐ Married with children☐ Married without children☐ 2 or more unrelated adults (domestic partnership) ☐ EDUCATION DID YOU OBTAIN A DIPLOMA/GED FROM HIGH SCHOOL OR VOCATIONAL/ TRADE SCHOOL YES ☐ NO☐ Did you attend College: YES ☐ NO☐ Have you earned an: Associates Degree ☐ Bachelor’s Degree ☐ Master’s Degree ☐ PhD ☐ OTHER SPECIALIZED TRAINING________________________ YOUR EMPLOYMENT & INCOME Full time YES ☐ NO ☐
Your Employer:
Starting date:
Job/Position Title
Town or City where you work:
2nd job Employer
Starting date:
Job/Position Title
Town or City where you work:
YOUR TOTAL GROSS MONTHLY INCOME $ before taxes
YOUR TOTAL NET MONTHLY INCOME $ after deductions
1
Full time YES ☐ NO ☐
CO-APPLICANT BIRTH DATE:
AGE:
Active Military? YES ☐ NO ☐ Veteran? YES ☐of NO Are you a citizen the ☐ United States? YES ☐ NO ☐
FIRST TIME HOME BUYER? YES ☐ NO ☐
GENDER:
Please answer both: Race: White☐ Black☐ Asian☐ Native Hawaiian☐American Indian☐ Multirace☐ Ethnicity: Not Hispanic ☐ Hispanic ☐ If not, do you have a Green Card? YES ☐ NO ☐ Country of Origin: ________________
Preferred Language: ENGLISH ☐ SPANISH ☐ PORTUGUESE ☐CREOLE ☐ OTHER ☐ ________________
EDUCATION DID YOU OBTAIN A DIPLOMA/GED FROM HIGH SCHOOL OR VOCATIONAL/ TRADE SCHOOL YES ☐ NO☐ Did you attend College: YES ☐ NO☐ Have you earned an: Associates Degree ☐ Bachelor’s Degree ☐ Master’s Degree ☐ PhD ☐ OTHER SPECIALIZED TRAINING________________________ EMPLOYMENT & INCOME Full time YES ☐ NO ☐
Your Employer:
Starting date:
Job/Position Title
Town or City where you work:
2nd job Employer
Starting date:
Job/Position Title
Town or City where you work:
YOUR TOTAL GROSS MONTHLY INCOME $ before taxes
YOUR TOTAL NET MONTHLY INCOME $ after deductions
Full time YES ☐ NO ☐
HOUSEHOLD INCOME Please PROVIDE THE monthly income for OTHER PEOPLE over 18 who will live in the new home Person # 1 relationship to you _________________________ co-applicant on loan YES ☐ NO ☐ TOTAL GROSS MONTHLY INCOME before taxes $ ___________TOTAL NET MONTHLY INCOME after deductions$ ________ Person # 2 relationship to you _________________________
co-applicant on loan
YES ☐ NO ☐
TOTAL GROSS MONTHLY INCOME before taxes $ __________TOTAL NET MONTHLY INCOME after deductions$ _________
I hereby certify that the information in this application is true and complete. ___________________________________________ ___________________________________________ Signature of Applicant Date Signature of Co-applicant or Co-purchaser Date
