Mortgage Counseling Questionnaire

Mortgage Counseling Questionnaire

NOTE:IF BOTH ADULTS ARE MARRIED OR LIVING TOGETHER THEY MUST COMPLETE THE APPLICANT AND CO-APPLICANT SECTIONS.(EVEN IF CO-APPLICANT IS NOT EMPLOYED)

Applicant
Name * First Last
Social Security Number *
Must be 9 digits. Currently Entered: 0 digits.
Date of Birth * / MM / DD YYYY
Physical Address - NO PO Box address - Include APT # if applicable *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Home Phone - ### - ### ####
Cell Phone * - ### - ### ####
Work Phone - ### - ### ####

*
	Married	Divorced	Separated	Single	Widow
Marital Status	Married	Divorced	Separated	Single	Widow

Spouse and or Co-Applicant
Name First Last
Social Security Number
Maximum of 9 digits allowed. Currently Entered: 0 digits.
Date of Birth / MM / DD YYYY
Email
Home Phone - ### - ### ####
Cell Phone - ### - ### ####
Work Phone - ### - ### ####


	Married	Divorced	Separated	Single	Widow
Marital Status	Married	Divorced	Separated	Single	Widow

Please answer the following questions: *
Please answer the following questions:	Yes	No
Does the applicant or co-applicant currently own a house or has either person owned a house within the past three years	Yes	No

Are you interested in an existing Habitat home?

Are you interested in an existing Habitat home? No Yes (Please list property address) Yes (Please list property address)
How did you hear about Habitat for Humanity *
Billboard Case Worker Employer Facebook Family/Friend Flyer Google Habitat Homeowner School Southside Reporter TV Radio Other Other
List all the names of the persons that will be living in the home (including yourself)
Name * First Last
Gender *

Gender Male Female
Relationship *
Age *
Veteran?
Monthly Income, if applicable $ . Dollars Cents
Name First Last
Gender

Gender Male Female
Relationship
Age
Veteran?
Monthly Income, if applicable $ . Dollars Cents
Name First Last
Gender

Gender Male Female
Relationship
Age
Veteran?
Monthly Income, if applicable $ . Dollars Cents
Name First Last
Gender

Gender Male Female
Relationship
Age
Veteran?
Name First Last
Monthly Income, if applicable $ . Dollars Cents
Gender

Gender Male Female
Relationship
Age
Veteran?
Name First Last
Monthly Income, if applicable $ . Dollars Cents
Gender

Gender Male Female
Relationship
Age
Veteran?
Monthly Income, if applicable $ . Dollars Cents
Name First Last
Gender

Gender Male Female
Relationship
Age
Veteran?
Monthly Income, if applicable $ . Dollars Cents
Name First Last
Gender

Gender Male Female
Relationship
Age
Applicant Income Information
Full-time Job

If hourly--
Per Hour ($) $ . Dollars Cents
Hours Per Week
If Salary --
Per Month ($) $ . Dollars Cents
Part-time Job (if applicable)

If hourly--
Per Hour ($) $ . Dollars Cents
Hours per Week
If Salary --
Per Month ($) $ . Dollars Cents
If you receive SSI, social security and/or child support, how much per month?
SSI $ . Dollars Cents
Child Support $ . Dollars Cents
Social Security $ . Dollars Cents
Co-Applicant Income Information
Full-time Job

If hourly --
Per Hour ($) $ . Dollars Cents
Hours per Week
If Salary --
Part-time Job (if applicable)
Per Hour ($) $ . Dollars Cents
Hours per Week
If Salary --
Per Month ($) $ . Dollars Cents
If you receive SSI, social security and/or child support, how much per month?
SSI $ . Dollars Cents
Child Support $ . Dollars Cents
Social Security $ . Dollars Cents
DEBTS (both applicant and co-applicant)

What are your current monthly payments? Ex. car payments, credit card,personal and/or student loans,child support. List all debts you are responsible for paying.
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Name/Type of Account
Monthly Payment $ . Dollars Cents
Balance $ . Dollars Cents
Credit Authorization (please read and sign)

I/We hereby give Habitat For Humanity of San Antonio, Inc. authorization to obtain information on my/our credit. Verification of such information may be made at anytime by the lender, its agents, successors or assigns either directly through a credit reporting agency.
Applicant Signature *

Clear
Co-Applicant Signature (required if you have co-applicant) *

Clear
Date signed / MM / DD YYYY