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Homebuyer Counseling
Pre-Purchase Counseling
Foreclosure Prevention
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Counseling Packet
Client Personal and Demographic Information
Full Name:
Date of birth
Address:
City:
State:
Postal code:
Home Phone:
Cell Phone:
I agree to
terms & conditions
provided by the company. By providing my phone number, I agree to receive text messages from the business.
Email
Gender:
Female
Male
Non-conforming / Other
Marital Status:
Single
Married
Separated
Widowed
Divorced
Disabled Status
Yes
No
Active Military:
Yes
No
Foreign Born:
Yes
No
if yes, what country?
Veteran Status:
Yes
No
Race:
Alaskan Native
Asian
Black
White
Native Hawaiian/ Other Specific Islander
Multiple Races
Other
Ethnicity:
Hispanic or Latino
Non-Hispanic
Education:
Below High School
High School Diploma or GED
Bachelor’s Degree
Some College
Junior or Vocational College
Master’s Degree or above
Household Size:
Annual Household Gross Income:
How many dependents live in your household?
What are their ages?
How many non-dependents live in your household?
What are their relationships to you?
I was referred to Help4Homes247 programs by:
Lender
Realtor
Government Agency
Internet
Walk-In
Friend/Family
Advertisement
Social Media
Staff/Board Member
Other
Housing Status
Current Housing Arrangement:
Renting
Living with friend/ family (not paying)
Homeowner with mortgage
Homeowner with mortgage paid
Homeless
Other
Number of years at current housing arrangement:
If renting, do you receive a rental subsidy?
Yes
No
If so, through which program?
Are you delinquent on your rent?
Yes
No
Months Delinquent:
Do you meet the definition of a first-time homebuyer? ( A first-time homebuyer does not currently own a home and has not owned a home within the past 3 years.)
Yes
No
Have you taken a Homebuyer Education Class?
Yes
No
If yes, date of class:
Do you have a contract on a house at this time?
Yes
No
Are you working with a real estate agent?
Yes
No
Employment
Employment Status
Employed
Self-employed
Unemployed
Hire Date
Primary Employer
Title
Gross Income
Is this amount paid:
hourly
weekly
every 2 weeks
twice a month
monthly
210-501-0732
