First Name*:

Middle Name:

Last Name*:

Current Address*: City*: State*: Zip*:

APPLICANT FORMPlease TYPE in fields and PRINT out completed application, if possible.

Otherwise, print application and handwrite clearly. *Indicates Required Field

Preferred Phone*:

Phone Type:

ex. (203) 555-5555

Email Address*:

Preferred Language*: English Spanish

How did you hear about NHS?*: (Check all that apply)

Bank/Lender Realtor Gov't

AgencyWebsite/Internet Ad/Flyer Word of

Mouth

Male Female

Number in Household*:

Head of the household?

Date of Birth*: (MM/DD/YYYY)

Social Security Number*: e.g. XXX-XX-XXXX

Marital Status*:

Single Married

Divorced Legally SeparatedEducation*:

Yes No Yes No

OtherSection 8

Rental Public/Subsidized Housing

High School/GED College Grad Degree

Some High School Some College Vocational

None

Primary

Country of Birth*:

Current Housing*: (Select one)

U.S. Citizen?*: If No, are you a pemanent resident?

Number of Children under the age of 18*:

Years at Present Address*:Current Monthly Rent*: $

Occupation*:

Employer*: Start Date* (MM/YYYY):

City of Employment*:

Second Occupation: (If applicable)

Second Employer: (If applicable)

Please TYPE or write clearly. The above information is for NHS internal purposes only and will be kept confidential.

APPLICANT:

1

Household Type*:

Other:

Female-headed single parent household

Married with Children

Male-headed single parent household

Married without Children

Single Adult Other

Two or more unrelated adults

Date:

Other: (Please specify)

Home Work Mobile

Yes NoAre you an active member of the US Military?*:

Alternate Phone*: ex. (203) 555-5555

Yes NoAre you a veteran?

3/18/15

First Name*:

Middle Name:

Last Name*:

Current Address*: City*: State*: Zip*:

CO-APPLICANT FORMPlease TYPE in fields and PRINT out completed application, if possible.

Otherwise, print application and handwrite clearly. *Indicates Required Field

Home Phone*:

Work Phone:

Cell Phone:

ex. (203) 555-5555

ex. (203) 555-5555

ex. (203) 555-5555 Email Address*:

Preferred Language*: English Spanish

How did you hear about NHS?*: (Check all that apply)

Another NHS Client Web News Bank/Lender Realtor NHS Event Mailer/Flyer

Male Female

Number in Household*:

Head of the household?

Date of Birth*: (MM/DD/YYYY)

Social Security Number*: e.g. XXX-XX-XXXX

Marital Status*:

Single Married

Divorced Legally SeparatedEducation*:

Yes No Yes No

OtherSection 8

Rental Public/Subsidized Housing

High School/GED College Grad Degree

Some High School Some College Vocational

None

Primary

Country of Birth*:

Current Housing*: (Select one)

U.S. Citizen?*: If No, are you a permanent resident?

Number of Children under the age of 18*:

Years at Present Address*:Current Monthly Rent*: $

Occupation*:

Employer*: Start Date* (MM/YYYY):

City of Employment*:

Second Occupation: (If applicable)

Second Employer: (If applicable)

Please TYPE or write clearly. The above information is for NHS internal purposes only and will be kept confidential.

CO-APPLICANT:

2

Household Type*:

Other:

Female-headed single parent household

Married with Children

Male-headed single parent household

Married without Children

Single Adult Other

Two or more unrelated adults

Date:

Yes NoAre you an active member of the US Military?*: Yes NoAre you a veteran?

3/18/15

Race/Ethnicity

The following information is requested by the Federal government to monitor compliance with Federal statues that prohibit discrimination in housing. You are not required to furnish this information, but are encouraged to do so.

APPLICANT

I do not wish to furnish this information.

Ethnicity

Single Race

Hispanic

Not Hispanic

Chose not to answer

American Indian/Alaska Native

Asian

Black or African American

White

White Hawaiian or other Pacific Islander

Multi-Race American Indian/Alaska Native and White

Asian and White

Black or African American and White

American Indian/Alaska Native and Black or African American

Other Multiple Race

Chose not to answer

CO-APPLICANT

I do not wish to furnish this information.

Ethnicity Hispanic

Not Hispanic

Chose not to answer

Black or African American

White

Single Race American Indian/Alaska Native

Asian

White Hawaiian or other Pacific Islander

Multi-Race

Chose not to answer

Other Multiple Race

American Indian/Alaska Native and Black or African American

Black or African American and White

Asian and White

American Indian/Alaska Native and White

3

3/18/15

First Name Last Name

HOUSEHOLD MEMBERS AND DECLARATIONSPlease TYPE in fields and PRINT out completed application, if possible. Otherwise, print application and handwrite clearly.

NY

What is the minimum number of bedrooms needed?

Male

Female

Female

Male

Female

Male

Male

Female

Male

Female

NY Y N NY

NY Y N Y N Y N

Male

Female

AgeGender Relationship to Applicant(s)

List everyone in the household who will be living in the new home (including applicant and co-applicant). Please list all adults first, with the applicant as #1 and co-applicant as #2, then children under 18.

In what city would you like to purchase a home?

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?

NYNYNY

NY NYY NY N

NYAre you a co-maker, co-signer, or endorser of any note or loan?

I understand that I must occupy the property as my primary residence.

Must be completed by anyone living in the new home who is 18 years of age or older.HOUSEHOLD DECLARATIONS Household Member 1

Household Member 2

Household Member 3

Household Member 4

I (We) understand that any intentional or negligent representation(s) of the information contained on this form may result in civil liability and/or criminal liability under the provisions of Title 18, United States Code, and Section 1001.

(Select Y for Yes and N for No)

Veteran? Disabled?

Annual Income

$

$

$

$

$

$

Applicant (Self)

Veteran? Disabled?

Veteran? Disabled?

Veteran? Disabled?

Veteran? Disabled?

Veteran? Disabled?

1)

2)

3)

6)

5)

4)

NY NY NYY NDo you currently own a home?

Are you interested in purchasing a multifamily property?

Yes No

4

Signature of Co-applicant or Co-purchaser Signature of Applicant Date

Photo release agreement:I authorize Neighborhood Housing Services of Phoenix, Inc. (NHSP) to use my photo in their marketing materials (newsletters, presentations, flyers, press releases, Web site, etc.) as appropriate. I understand that NHSP will not sell the rights to these photos nor will they pay any royalties for their use. As a courtesy and whenever possible, NHSP will provide copies of any printed materials in which this photo appears. Initials: ______

3/18/15

Name:

FINANCIAL INFORMATION FORM Please TYPE in fields or handwrite neatly. Fill in fields as completely as

you can, including all Current Monthly Expenses that apply to you.

Please TYPE or write clearly. The above information is for NHS internal purposes only and will be kept confidential.

MONTHLY EXPENSES

5

Date:

Current ($) As a HomeownerSAVINGS Budgeted Each Month

Rent Mortgage PaymentRental Insurance Property Taxes

Parking Homeowner's Ins.Maintenance

HOA FeesCar Loan(s)

Car InsuranceGasoline

Maintenance/Repairs

Public Transportation

Heat

Electricity

Water/Sewer

Trash Pick-up

Cable TV

Internet

Cell Phones

Telephones (land line)

Child Support/AlimonyCredit Card Minimum Payments

Installment/Personal Loans

Student Loans

Other Loans

Groceries

Dining Out

Food at Work

Child Care

TuitionSchool Fees/Books and Supplies

School Meals

Medical Insurance

Doctors

Dentist

Medications

Life Insurance

Tuition

ClothingChurch or Other Donations

Miscellaneous

MONTHLY INCOME

Applicant: $

Co-applicant: $

Earned Monthly Income After Taxes

Child Support: $

Social Security: $

Other Monthly Income

$Other:

TOTAL INCOME = $

HO

USI

NG

AU

TOU

TILI

TIES

DEB

TSFO

OD

CH

ILD

REN

MED

ICA

LO

THER

$TOTAL INCOME - TOTAL EXPENSES =

TOTAL EXPENSES = $ $

AMOUNT SAVED

$Towards Home (total):

Water/Sewer

Trash Pick-up

Car Loan(s)

3/18/15