Western Arizona Council of Governments | WACOG - As a ... · Web viewLa Paz Career Center (928-669-9812), Mohave Community College Pre-College Studies 928-757-0866, Adult Literacy

A HAND UP HOUSING COUNSELING PROGRAM (Intake Application)WACOG is a HUD-approved Local Housing Counseling Agency. Our experienced Housing Counselors are dedicated to helping you succeed, whether you are purchasing your first home, renting, maintaining your home, trying to avoid delinquency or foreclosure, or just need to get on financial track.

Along with this packet you will receive an Intake Form. Please fill it out and return it to our front desk staff. The Intake Form will be reviewed by our Housing Counselors and you will be contacted within 2 business days for follow-up.

If you are eligible for an appointment, please fill out this packet and bring it with you to your appointment, along with the following documents:

1. Most recent 60 days of income: paystubs and/or other documentation that verifies your income (ie., unemployment, social security)

2. If self-employed: most recent quarterly and year to date (YTD) profit/loss statements

3. Most recent two month bank statements (all pages) for all accounts

4. Last two years’ IRS tax returns with all schedules and W2’s attached

5. Verification of your identity: driver’s license, social security card or passport (same as citizenship info?)

6. Mortgage statement(s), all correspondence delinquency notices, Notice of Default Trustee Sale

7. If applying for mortgage relief: a hardship letter describing the circumstances that caused your financial situation, what your plans are for the property and how you intend to achieve your goal

8. Copy of divorce documents or other court documents if you relied on alimony or child support as qualifying income to secure a loan and/or show responsibility for mortgage payment

9. Any other income: SNAP (Food Stamps), pension statements, retirement statements, 401K’s, etc.

Thank you,Western Arizona Council of Governments

Sherri Tate Yuma County/La Paz County 928-217-7161Regina Gonzalez Yuma County/La Paz County 928-217-7160Joyce Lucero Mohave County 928-377-1058

INTAKE 1 August 2017

CIS/CAP60#: ____________________________

HAND UP HOUSING COUNSELING PROGRAM – INTAKE / DEMOGRAPHIC DATAClient 1

Name: Address:Tel: City, State, ZIP:Email: Preferred Language:Gender: M F Marital Status: S M D SP WVeteran: Yes / No Disabled: Yes / NoDOB: Age: Highest Education Level:SSN:

Race○ White○ Black/African American○ Asian○ American Indian/Alaskan Native○ Native Hawaiian/Other Pacific Islander○ American Indian/Alaskan Native and White○ Asian and White○ Black/African American and White○ American Indian/Alaskan Native & Black/African American○ Other

Ethnicity○ Hispanic White○ Hispanic Black/African American○ Hispanic Asian○ Hispanic American Indian/Alaskan Native○ Hispanic Native Hawaiian/Other Pacific Islander○ Hispanic American Indian/Alaskan Native and White○ Hispanic Asian and White○ Black/African American and White○ Hispanic American Indian/Alaskan Native & Black/African American○ Hispanic and Other

Client 2Name: Address:Tel: City, State, ZIP:Email: Preferred Language:Gender: M F Marital Status: S M D SP WVeteran: Yes / No Disabled: Yes / NoDOB: Age: Highest Education Level:SSN:

Race○ White○ Black/African American○ Asian○ American Indian/Alaskan Native○ Native Hawaiian/Other Pacific Islander○ American Indian/Alaskan Native and White○ Asian and White○ Black/African American and White○ American Indian/Alaskan Native & Black/African American○ Other

Ethnicity○ Hispanic White○ Hispanic Black/African American○ Hispanic Asian○ Hispanic American Indian/Alaskan Native○ Hispanic Native Hawaiian/Other Pacific Islander○ Hispanic American Indian/Alaskan Native and White○ Hispanic Asian and White○ Black/African American and White○ Hispanic American Indian/Alaskan Native & Black/African American○ Hispanic and Other


Current Employer Client 1:

_______________________________________________

Current Employer Client 2:

_____________________________________________________

Address:

_______________________________________________

Address:

_____________________________________________________

Start Date: ____________________________ Start Date: ____________________________

Salary: $______________ per _____________ Salary: $______________ per _____________

Farm Worker? ___ Yes ___ No Farm Worker? ___ Yes ___ No

Others Living in Household

NameMale orFemale Age Relationship Dependent? Elderly? Disabled?

Highest Education Level

AFFIDAVIT THAT DOCUMENT(S) IS/ARE TRUE

I, (printed name) ________________________________________, swear or affirm, under penalty of perjury, that the documents presented by me to prove US Citizenship, US National or legal resident status are true.

Documents Presented: (do they only need one?)

Driver’s license issued after 1996 or State IDBirth certificate or delayed birth certificateUS certificate of birth abroadUS passport / Legal Resident CardForeign passport with a US VisaI-94 form with photoUS citizenship and immigration services employment authorization or refugee documentUS certificate of naturalizationUS certificate of citizenshipTribal certificate of Indian bloodTribal or Bureau of Indian Affairs affidavit of birth

I certify that to the best of my knowledge that the statements made on this document are true and correct. I understand that it may be a Federal crime to knowingly make any false statements concerning any of the above as applicable under the provisions of the United States Criminal Code.

Signature: ________________________________________ Date: ____________________________________

AUTHORIZATION TO RELEASE INFORMATIONINTAKE 3 August 2017

Date: ______________________________________________

To: ______________________________________________

Loan Acct # ______________________________________________

Borrower Name(s): ______________________________________________

Property Address: ______________________________________________

I/we are working with Sherri Tate (928) 217-7161, Joyce Lucero (928) 377-1058, and/or Regina Gonzalez (928) 217-7160, housing counselors with Western Arizona Council of Governments (WACOG), a HUD-approved housing counseling agency. I/we hereby authorize you to release any and all information concerning my/our mortgage loan and/or accounts to the COUNSELORS named above or any other WACOG representative.

Thank you.

Signature: ______________________________________________

Last 4 #s of Soc Sec ______________________________________________

Signature: ______________________________________________

Last 4 #s of Soc Sec ______________________________________________

HAND UP HOUSING COUNSELING PROGRAM – DISCLOSURE and PRIVACY STATEMENTINTAKE 4 August 2017

WACOG is a US Department of Housing and Urban Development (HUD) approved Local Housing Counseling Agency.

The program offers one-on-one housing counseling in the following areas: Pre-Purchase, Post-Purchase, Resolving/Preventing Mortgage Delinquency, Rental, Predatory Lending, Homeless and Home Equity Conversion Counseling (Reverse Mortgage). The program also offers Pre-Purchase, Foreclosure Prevention, Building A Better Spending Plan and Understanding Credit workshops.

By signing this document you acknowledge that you are under no obligation to receive the program’s services.

By signing this document you acknowledge that WACOG does not have financial relationships with or endorses lenders, mortgage loan products, and/or real estate companies/agents. Any perceived or real contradiction to this statement must be immediately reported to Gina Whittington, Human ServicesDirector, 1235 S Redondo Center Drive, Yuma, Arizona 85364, 928-217-7123.

By signing this document you acknowledge that participating in the housing counseling program does not obligate you to participate in other programs offered by WACOG. However, during the course of counseling delivery, your Housing Counselor may refer you to WACOG’s Head Start, the Area Agency on Aging, Human Services and/or to other local community agencies. You are not obligated to accept referral(s).

By signing this document you acknowledge that the information provided by the Housing Counselor is not a substitute for legal or tax advice from a licensed attorney or tax accountant. You also acknowledge that WACOG is not a loan company or real estate agency and WACOG does not guarantee any specific results or outcomes.

If you are a participant of WACOG’s homebuyer group education workshop or receiving pre-purchase counseling, by signing this form you acknowledge that you have received the documents: a. Ten Important Questions to Ask Your Inspector and b. For Your Protection: Get a Home Inspection.

A Hand Up Housing Counseling Program is partially or fully funded by HUD/Rural Community Assistance Corporation, the Community Services Block Grant, City of Yuma Community Development Block Grant, the National Council on Aging, Yuma County United Way and the National Mortgage Settlement fund (AZ Attorney General’s Office). In order to comply with funder requirements, demographic data such as race, ethnicity, and income may be requested. WACOG does not discriminate on the basis of demographic variables and provides services to all eligible households. Housing counseling is free unless otherwise disclosed.

WACOG housing educators/counselors respect clients’ right to privacy. Private information will be requested from clients only as it is necessary to providing services. Once personal information is shared, privacy laws apply as well as client confidentiality.

WACOG housing educators/counselors will disclose confidential information only as specified by valid written consent of client, or as required by law.

WACOG housing educators/counselors will disclose clients’ information, including their identity only as is reasonable in the conduct of business and/or as the client approves.

WACOG housing educators/counselors will protect the confidentiality of clients’ written and electronic records and other sensitive information. Clients’ records shall be stored in a secure location and not made available to unauthorized parties.

WACOG housing educators/counselors will honor the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology.

WACOG housing educators/counselors will dispose of clients’ records in a manner that protects clients’ confidentiality and is consistent with state statutes governing records._______ By initialing here you acknowledge receipt of our grievance resolution process form.

________________________________ _________________________

Signature Date

________________________________ _________________________

Signature Date

Hand Up Housing Counseling Program


GRIEVANCE PROCEDURES

Any client having a complaint regarding services provided, quality of service, or denial of service by an employee of Western Arizona Council of Governments for any reason, including alleged discrimination on the basis of age, sex, religion, race, national origin or handicap, has the right to appeal according to the following procedure:

1. A written complaint should be made to the Human Services Director regarding the grievance. The complaint should be hand delivered or mailed within three (3) working days of the alleged occurrence to

Human Services Director

1235 S Redondo Center Drive

Yuma, AZ 85365

2. The Human Services Director, appropriate coordinator and/or immediate supervisor will discuss the issue with the client and with the employee. A decision will be made by the Human Services Director. The Executive Director will approve or modify the decision. Both the client and the employee will be notified of the decision and what action is deemed appropriate. Notification to all concerned will take place within a reasonable time, not to exceed ten (10) working days, from the date of the complaint.

3. A file regarding the complaint will be retained by Western Arizona Council of Governments.

Acknowledgement of receipt for this procedure is made by initialing where indicated on the Hand Up Program Disclosure Statement form.




A HAND UP HOUSING COUNSELING PROGRAM – Client and Counselor Agreement Counselor agrees to provide:

Confidentiality, honesty, respect and professionalism Development of spending plan, both short-term and long-term plans if applicable Analysis of mortgage default if applicable (amount, cause) Analysis of household budget and credit issues Explanation of the foreclosure process and possible consequences if applicable Explanation of reasonable options available, if any Assistance with communicating with mortgage servicer and assistance with meeting servicer requirements Assistance with understanding the home rental, purchase or disposition process Identification and referrals to community resources

Client agrees to:

Provide honest and complete information (verbal and written) Provide the documents requested by the Counselor and within set timeframe Call the business day prior to the appointment if unable to attend a scheduled appointment Arrive on time for scheduled appointments (in late for an appointment may result in re-scheduling) Contact the Counselor to report changes in financial situation Refrain from using cell phones during counseling sessions

I/We understand that not complying with this Agreement may prompt the Counselor to close my/our case and determined I/we have withdrawn from counseling.

______________________________________ _________________________Homeowner Signature Date

______________________________________ _________________________Homeowner Signature Date

______________________________________ _________________________Counselor Signature Date

BUDGET WORKSHEET


Client Name: Date: Income Gross Salary Gross Salary Child Support Spousal Support Retirement Retirement Social Security x 1.25 Social Security x 1.25 Investment Income Rental Income Other Total Household Income Monthly Fixed Expenses Rent Renters Insurance Mortgage 1 Mortgage 2 Property Tax (If not included in mortgage) HOA Fees Homeowners Insurance (If not included in mortgage) Total Housing Costs Front End Ratio (Housing) Auto Loan or Lease Auto Loan or Lease Home Equity Loan Student Loan(s) Other Loan(s) Child Support Paid Alimony Paid Credit Card 1 Credit Card 2 Credit Card 3 Credit Card 4


Credit Card 5 Store Card(s) (total) Gas Card(s) (total) Other Credit Lines Not Included Other Total Monthly Fixed Expenses Back End Ratio Monthly Variable Expenses Medical/Dental Payments Life Insurance Car Insurance Health Insurance Long-Term Care/Disability Insurance Electricity Gas Water Garbage Sewer Phone (Home) Cell Phones Cable/Satellite Internet Access Groceries Eating Out (include restaurants, fast food, lunches, etc) School (Fees, Lunches, Tuition, Year Book) Gasoline, Tolls, Parking, Registration Public Transportation - Bus, Taxi, Train, Subway Repairs (Home, Car, Etc.) Health Club Membership Daily Coffee/Snacks Laundry/Dry Cleaning Household Items (not grocery) Pet Care and Supplies Baby Items Children's Allowances Personal Grooming (Hair Cuts, Nails, Cosmetics)


Clothes Entertainment: Movie Theater (include drinks, popcorn etc.) Movie/Game Rental Cable On-Demand Movies Sports Event: Gamer, Races Concerts Play/Dinner Theater Recreation/Day Trips Other CDs/DVDs Club Dues Babysitter/Day Care Lessons: Music/Sports/Tutoring Vacation(s) ATM Withdrawals (if you have not already included) Bank Fees Computer/Online Expenses Retirement Savings Emergency Fund Gifts Donations STORAGE/Yard/Pool Service Occupational Licenses/Fees Retirement Savings Tobacco/Alcohol Magazine Subscriptions Misc. Spending Money Postage Other Total Monthly Variable Expenses Total Expenses Variance



As a HUD-Approved Housing Counseling Agency, it is our goal to provide community outreach to educate, counsel and advocate for those within our community who feel they have experienced housing discrimination or simply would like more information on the Fair Housing Act. We are here to provide expert counseling and educational services whether you are purchasing or renting a home and all of the steps in-between.

Fair Housing. It’s Your Right. Use it.

2017 Yuma Fair Housing Poster Design Winner: Francisco Fuentes, Arizona Western College

SIGNS OF POSSIBLE HOUSING DISCRIMINATION

Refusing to sell, rent, or show available housing. Only showing housing in areas where other minorities live. Harassment or intimidation. Housing advertisements with discriminatory statements or displaying no minorities in group scenes. Differing terms for identical dwellings. Extensive questioning prior to offering or providing information about the availability of housing. Being told the dwelling is not appropriate for your family. Terms of availability change between phone contact and your visit. You are not contacted after the acceptance of your application. House or apartment has an “available” sign but you are told it is not available. Refusing to make reasonable accommodation or allow a

modification to make the dwelling accessible for a person with a disability. Refusing to finance the purchase of a home or to write property insurance, or offering non-standard and

unfavorable terms

If you feel you have a Fair Housing issue and your rights have been violated, contact A Hand Up Housing Counseling. We will meet with you about your situation and provide you with expert guidance.

Fair housing is not an option, it’s the law and WACOG Housing Counselors are here to assist.


COMMUNITY RESOURCES - Please keep this page.

The information below is also found in our booklet People’s Information Guide.

Foreclosure Law Project/Community Legal Services (fraud and scam investigations. all counties, 800-852-9075)SAVE OUR HOME AZ, Arizona Department of Housing (azhousing.gov) / HUD.GOVSouthwest Fair Housing Council (fair housing discrimination, reporting, testing, 888-624-4611), HUD.GOVNational Council on Aging (reverse mortgages) 855-899-3778Arizona Attorney General’s Office (azag.gov/foreclosure)WACOG:Head Start (All Counties, 928-782-1886)Area Agency on Aging (programs and services for adults 60+, all counties 928-782-1886)Community Action Programs (utilities, rent/mortgage, housing programs, Volunteer Income Tax Assistance/ EITC, weatherization, TANF, housing counseling and financial literacy, advocacy and referral, all counties 928-782-1866)Arizona Department of Economic SecurityChild Care (La Paz 928-669-8385, Kingman 928-753-6621, Bullhead City 928-704-7776, Lake Havasu City 928-854-2371)Domestic Violence/Shelter and AdvocacyAmberly’s Place, Shelter in Yuma County for Victims of Domestic Violence, 928-373-0849Colorado River Regional Crisis Shelter (Parker, AZ 928-669-0107)Lake Havasu Interagency Council (Lake Havasu City, 928-855-8877)Homeless Shelters: Crossroads Mission 928-783-9362 (Yuma), Cornerstone Mission 928-757-7535 (Kingman)Housing Authorities (vouchers/rental assistance) Yuma County 928-782-3823, Mohave County 928-753-0723 Supplemental Nutrition Assistance (Food Stamps) 800-352-8401Employment (Workforce Investment Act: La Paz 928-669-9812, Mohave 928-753-0723, Yuma 928-329-0990)Vocational Rehabilitation (for individuals with disabilities) 602-266-6752Yuma Private Industry Council, 928-783-9347Adult EducationLa Paz Career Center (928-669-9812), Mohave Community College Pre-College Studies 928-757-0866, Adult Literacy Plus of Southwest AZ 928-343-9363Social Security Income (SSI) 800-772-1213PMHDC Farm worker Housing 731 N 1st Ave, San Luis, AZ 85349 928-627-3203
