NHS Intake Form

CREDIT AUTHORIZATION & PRE-QUALIFICATION FORM

MRP 2.0

To start the application process, please fill out the form below and note the following important requirements:

All contact information fields must be completed for the applicant, as well as for the co-borrower if one is added to the application.
Signatures for the applicant and any co-borrower will be obtained digitally before final form submission by signing on screen with a mouse, or using a finger on touchscreen devices. The signatures will be automatically added to all necessary privacy, disclosure, eligibility, etc. forms required for the application process, and then sent as PDFs to all parties via email.

PRIMARY APPLICANT

PRIMARY APPLICANT EMPLOYMENT & EDUCATION

PRIMARY APPLICANT INCOME

MONTHLY TOTALS

CO-BORROWER

CO-BORROWER EMPLOYMENT & EDUCATION

CO-BORROWER INCOME

MONTHLY TOTALS

CO-APPLICANT

HOUSEHOLD MONTHLY EXPENSES

Rent / Mortgage:

Water:

Rental Insurance:

Electric:

Homeowner's Insurance:

Eating Out:

HOA:

Groceries:

Property Taxes:

Phone/Cell:

Other Mortgage(s):

Cable/Satellite:

Credit Cards(minimum payment):

Internet:

Installment Loans:

Entertainment:

Student Loans:

Child Care / Tuition:

Car Payment:

Medical:

Car Insurance :

Contributions/Donations:

Gas / Transportation:

Other:

TOTAL MONTHLY EXPENSES

HOUSEHOLD CASH FLOW

HOUSEHOLD ASSETS

LIQUID ASSETS

HARD ASSETS

Checking:

Home Property Value:

Checking:

Other Property Value:

Savings:

401(k) / Retirement:

Stocks / Bonds / CD's:

Other Assest:

TOTAL LIQUID ASSETS:

TOTAL HARD ASSETS

TOTAL ASSETS:

ELIGIBILITY INFORMATION

List all Members of the Household

LIST ALL MORTGAGES

Please email a copy to [email protected]

Please email a Letter of Explanation (LOE) to [email protected]

If you are not able to qualify for foreclosure prevention, would selling the property be a consideration?

HOME REPAIR

TENANT INFORMATION

1. I/We understand that Neighborhood Housing Services of Los Angeles County (NHS) and it partners provide home buying counseling provides home maintenance counseling provides delinquency and default mortgage counseling after which I will receive an action plan consisting of recommendations for handling my finances, possibly including referrals to other agencies as appropriate.

2. I/We acknowledge that I have received a copy of NHS' Privacy Policy and Disclosure of Programs & Services.

You must click both download links below before checking the acknowledgement box.

Download
Privacy Policy PDF Download
Disclosure of Programs & Services PDF

3. I/We understand that Neighborhood Housing Services of Los Angeles County receives funds through various funders and grant administrators and, as such, I authorize NHS, if required by the program guidelines to (a) submit client-level information to the program for this grant, (b) allow my file to be reviewed for program monitoring and compliance purposes, and (c) conduct follow-up with me related to program evaluation.

Check here to opt out of provision for funders or grant administrators to follow-up with related program evaluation.

4. I/We may be referred to other housing services of the organization or another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.

5. A counselor may answer questions and provide information, but not give legal advice. If I want legal advice, I will be referred for appropriate assistance.

6. I/We authorize NHS or its partners to pull my/our credit report(s) as part of the counseling to be received.

7. The counseling services, lending products, affordable housing and other forms of assistance that may be offered by Neighborhood housing Services of Los Angeles County, its' affiliates, directors, officers, employees or agents may also be offered by other providers. I understand that I am under no obligation to accept affiliate services.

6. The counseling services, lending products, affordable housing and other forms of assistance that may be offered by Neighborhood housing Services of Los Angeles County, its' affiliates, directors, officers, employees or agents may also be offered by other providers. I understand that I am under no obligation to accept affiliate services.

7. I/We certify that this information is true and correct

APPLICATION SIGNATURE(S)

Mobile & tablet users should turn their device to landscape/sideways mode for the signing process (before clicking this button).

Once you're ready to sign the form, CLICK HERE to activate the signature pad. Sign by using your mouse or touchscreen. Once you click the checkmark to accept your signature, the form will be ready to submit.

Please Wait.
Do not refresh or resize your browser or rotate your device.
(This may take a few moments as signed PDFs are being generated.)

NHS Intake Form

CREDIT AUTHORIZATION & PRE-QUALIFICATION FORM

MRP 2.0

To start the application process, please fill out the form below and note the following important requirements:

Course Requirement

Course Requirement

Workshop Requirement

Not Eligible

PRIMARY APPLICANT

PRIMARY APPLICANT EMPLOYMENT & EDUCATION

PRIMARY APPLICANT INCOME

CO-BORROWER

CO-BORROWER EMPLOYMENT & EDUCATION

CO-BORROWER INCOME

CO-APPLICANT

HOUSEHOLD MONTHLY EXPENSES

HOUSEHOLD ASSETS

ELIGIBILITY INFORMATION

LIST ALL MORTGAGES

HOME REPAIR

TENANT INFORMATION

APPLICATION SIGNATURE(S)

Get In Touch

Business Services

Program Services

Photos

Video

General Services

Visit NHS:

NHS Intake Form

CREDIT AUTHORIZATION & PRE-QUALIFICATION FORM

MRP 2.0

To start the application process, please fill out the form below and note the following important requirements:

Course Requirement

Course Requirement

Workshop Requirement

Not Eligible

PRIMARY APPLICANT

PRIMARY APPLICANT EMPLOYMENT & EDUCATION

PRIMARY APPLICANT INCOME

CO-BORROWER

CO-BORROWER EMPLOYMENT & EDUCATION

CO-BORROWER INCOME

CO-APPLICANT

HOUSEHOLD MONTHLY EXPENSES

HOUSEHOLD ASSETS

ELIGIBILITY INFORMATION

LIST ALL MORTGAGES

HOME REPAIR

TENANT INFORMATION

APPLICATION SIGNATURE(S)

Get In Touch

Business Services

Program Services

Photos

Video

General Services

Visit NHS:

Your support is always needed

At all levels of giving, your generosity touches families.