Foreclosure Prevention Counseling


Co-Homebuyer Information

The following information is requested by the federal government in order to monitor compliance with federal statutes that prohibit discrimination in housing. You are not required to furnish this information but are encouraged to do so. The law provides that a lender/servicer or counseling agency may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, the lender/servicer or counseling agency is required to note the information on the basis of visual observation or surname if you have made this request for a loan or counseling assistance in person. If you do not wish to furnish the information, please check the box below

Homebuyer Education

Co-Homebuyer Education

Homebuyer Employment Information

Co-Homebuyer Employment Information

Other Income Sources

All entries should reflect annual amounts. For example, if your present salary is $2,000 per month, line 1 would be $24,000 ($2,000 x 12). Documents must include the most recent 30 days income. 1. W2 wage jobs paystubs showing employer name, address and phone, employee name, year-to-date gross earnings, gross hourly or salary payment rate for the pay period; and number of hours worked in the pay period. Plus, fees, tips and bonuses, and other compensation for personal services. 2. Business, self-employment and gig economy jobs require most recent quarterly profit and loss statement, all pages of statements for all bank accounts (business and personal) for the same three-month period, and most recent tax return with all schedules. 3. Interest, royalty, and dividend income require most recent tax return with all schedules. Or if one has a 6-month average checking balance of $6,000 in an interest-bearing account using the current Passbook Rate of .02, the income generated from the checking account would be $120 or ($6,000x.02 = $120). 4. Retirement, insurance, Social Security income should include the full amount of periodic payments received from Social Security, annuities, insurance policies, retirement funds, pensions, or death benefits, and other types of periodic receipts. 5. Unemployment, disability, worker's compensation, and severance pay should include payments in lieu of earnings, such as unemployment and disability compensation, workers comp and severance pay. 6.Welfare Assistance, government cash assistance and housing subsidies require most recent award letter or payment statement. 7. Alimony, Child Support, & Gift Income require most recent award letter, divorce decree, court document or payment statement. 8. Armed Forces Income require most recent award letter or payment statement. You must provide supporting documentation for each entry on the income worksheet that applies to your household. Failure to supply adequate documentation will result in the return of your application.


If there are additional liens/mortgages or judgments on this property, please name the person(s) or company and give the following information. (Use additional paper if necessary.)