Workshop Registration Form Logo
  • Workshop Registration Form

    Pre-Purchase and Financial Education Workshops
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  • Thank you for your interest in the Pre-Purchase and/or Financial Education Workshops! 

    Please complete the forms below in its entirety and choose your workshop date(s) at the bottom. Next, you will need to complete the pre-workshop paperwork attached to this registration on the next pages. The estimated time to complete all of the forms is around 15 minutes. 

    A FHAS Staff Member will reach out to you via email within 5 business days or less to confirm your seat in the workshop you have selected. 

  • About You

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  • Please Note: Co-Applicant information is required if you have selected Married, Separated or CoHabitating

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  • About Your Residence

  • About Your Income

  • About Your Family

  • Please review the Household Types below

    and select yours from the dropdown

    Single Adult = No children, living alone

    Female or Male headed household = One adult with children (no partners)

    Married with Dependants = Two married adults with children

    Married without children = Two married adults with no children

    CoHabitating = Living with unmarried partner(s), may have children or not

    Two or More Unrelated Adults = Living with roommate(s), may have children or not

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  • Pre-Purchase & Financial Education Workshops

    Please select a workshop you would like to attend. More than one workshop can be selected.
  • Pre-Purchase Workshop

    Please select a pre-purchase workshop date from the pull-down menu below.
  • Pre-Purchase Workbook

    Sponsored by Pinnacle Bank
  • Pre-Purchase Workbook

    Sponsored by Pinnacle Bank through the July 2024 workshop. Beginning with the August 2024 workshop, the regular $30 workbook fee will be the client's responsibility or, if applicable, covered by the program's referral
  • Financial Education Workshop

    Please select a financial education workshop date from the pull-down menu below.
  • My/Our signature(s) certify that all the information provided on this intake form is accurate and complete to the best of my/our knowledge.

    Failure to attend a scheduled Financial Education, or Pre-Purchase Education workshop, OR, rescheduling a workshop  3 consecutive times within a calendar year, will result in ineligibility to schedule a workshop until the following calendar year.

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  • Authorization to Obtain & Release Information

    Family Housing Advisory Services, Inc.
  • This form is valid for the following workshops: Financial Education, Pre-Purchase, and Post-Purchase workshops.

    I/we, {yourName} ,{coapplicantName} do hereby:
    Authorize FHAS to share information about me/us, but not limited to, information provided pursuant to the terms of this Authorization to Obtain & Release Information and to speak with any person/organization, its agents and employees solely for the purpose of assisting me/us. FHAS does not release information to any third-party agencies for the purpose of marketing.
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    Authorize the release of any and all required information regarding each of my/our accounts and loans to any representative of Family Housing Advisory Services, Inc. (FHAS). I/we understand that the information released may include, but is not limited to, verbal, written, or printed information relating to my/our accounts(s) and payment transactions, copies of loan documents and any record of communication history associated with my/our account(s) and loan(s). I/we further authorize verbal communication and consultation with any representative of FHAS regarding all aspects of my/our account(s) and account history, including information provided by any other party.
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    Agree to hold FHAS harmless as a result of their good faith attempt to assist me/us and understand that FHAS will maintain the confidentiality of my/our non-public personal information in accordance with its policies and applicable federal and state law.
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  • Refusal to sign this Authorization to Obtain and Release Information will NOT result in a denial of services, but FHAS will not be able to negotiate or obtain information on your behalf. A copy or scan of this document will be considered an original for all intents and purposes.

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  • Primary Applicant Name: {yourName} Co-Applicant Name: {coapplicantName}
    {startDate}

  • Current Address: {currentAddress}
    Referring Agency: {referredBy}

  • FHAS Employee (for office use only):

     ___________________________

     Family Housing Advisory Services, Inc.

    MAIN OFFICE

    2401 Lake Street

    Omaha, NE 68111

    402.934.7921/Fax 402.934.7928

     Increasing Affordable Housing Opportunities for All

    Certified by the United States Department of Housing and Urban Development (HUD) to provide comprehensive Housing Counseling Service. TTD Access via the Nebraska Relay System.       Rev.2022

  • Privacy Policy

    Family Housing Advisory Services, Inc.
  • Privacy Policy - Opt Out

    If your account is active, and you are not comfortable with this level of information sharing, please contact us to inactivate your account. If your account is inactive, your information is no longer used internally or externally, except for record keeping, governmental, and audit purposes.

     Direct Mail: Family Housing Advisory Services, Inc.

    2401 Lake Street

    Omaha, NE 68111

    Phone: 402-934-6471

    Attn: Donna

  • Privacy Policy

    You are receiving this statement to comply with federal laws regarding the disclosure of non-public information. FHAS is committed to fully protecting and preserving the privacy of our clients. For your protection, please take a few moments to read this statement:

    As part of our committment to your privacy, FHAS will only disclose the information that it must in order to serve you in the most effective manner possible. Hence, FHAS will not distribute client information to third parties, except where it is necessary to perform quality services or its clients, as described below.


    This Applies To

    This statement applies to those individuals who have received education and/or one-on-one counseling assistance, and with whom there is a continuing counselor/client relationship.


    Information Collected

    Through telephone, fax, mail, and electronic communication, personal information will be gathered, including address, social security number, telephone number, email address, and other demographic information. Through the aforementioned channels, financial information will also be collected, including information related to your debts, income, expenses, and checking/savings accounts on an as-needed basis. Please be assured that we carefully train all of our counselors to carefully protect all client information. In order to do this effectively, we will ask for information that only you should know when you contact us. No one else can call in and access your information without your written authorization. If you find, at any time, that our records contain inaccurate or incomplete records, please let us know immediately.


    Internal Sharing

    Information may be shared with FHAS as needed to assist with situations that may arise.


    External Sharing

    A necessary portion of your personal and financial information will be used to communicate with your creditors and/or lender to coordinate with them on your behalf. Information will not be sold to corporations. FHAS does not report any information to credit bureaus.


    Other Applicable Laws

    The practices described above are in accordance with federal privacy law. You may have other protections under applicable state laws. To the extent that these state laws apply, we will comply with them when we share information about you.


    Protections for Information

    Physical and electronic files are only kept within the confines of the FHAS offices and at approved secure backup sites. Access is restricted to authorized personnel only.


    Information Storage

    The information you supply FHAS will remain in corporate files for as long as it is necessary to provide services, and for a reasonable period of time following the completion or termination of services.

    Online Privacy

    Information may be gathered when you visit the FHAS website, including Internet Protocol (IP) addresses, Uniform Resource Locator (URL) tags, and basic operating system and browser information. Electronic security is maintained through use of firewalls (which are designed to protect systems from intrusion). All information collected through the Jotforms website is encrypted upon submission and is not sold to third-party affiliates per a licensed BAA between both parties.

    Notes

    FHAS refers to the Family Housing Advisory Services, Inc. a Housing and Urban Development (HUD) Housing Counseling Agency. FHAS is also an agency of United Way of the Midlands.

    How You Can Help Protect Your Privacy

    Do not share your account information, passwords, user IDs, PINs, your SSN, code words or other confidential information with others.

    Do not provide confidential information to unknown callers.
    Do not provide confidential information online unless YOU initiated the contact, know the party with whom you're dealing, and can provide the information through a secure line (https://).
    When conducting business over the internet, always use a secure browser & exit onlineapplications as soon as you finish using them.
    If you believe you have been the victim of identity theft or fraud, please call the Social Security Administration Fraud Hotline at 800-397-0271 to report fraudulent use of your identification information.
    File a complaint with the Federal Trade Commission (FTC) by contacting the FTC's Identity Theft Hotline: 877-ID-THEFT (877-438-4338).
    File a police report and retain the police report number and officer's name and badge number that took the report.
     

    Credit Bureau Fraud Lines:

    Experian: 888-397-3742

    Equifax: 800-525-6285

    TransUnion: 800-680-7289

     

    I/we acknowledge that I/we received, read, and agree to Family Housing Advisory Services, Inc.'s Program Privacy Policy.

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  • Primary Applicant Name: {yourName} Co-Applicant Name: {coapplicantName}
    Date: {startDate}

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  • HUD Program Disclosure Form

    This form is valid for the following workshops: Financial Education, Pre-Purchase, and Post-Purchase.
  • Note: If you have an impairment, diability, language barrier, or otherwise require an alternative means of completing this form or accessing information about arranging alternative accommodations, please talk to your housing counselor about arranging alternative accommodations. In the designated areas on this form, please initial, sign, and date.

     

    About FHAS and Program Purpose:

    Family Housing Advisory Services, Inc. (FHAS) is a nonprofit, Housing and Urban Development (HUD) approved comprehensive housing counseling agency and also an agency of the United Way of the Midlands. We provide education workshops and a full-spectrum of housing counseling services including: Pre-Purchase, Post-Purchase, Foreclosure Prevention, Financial Education, Individual Development Account (IDA), Earned Income Tax Credit, Fair Housing, Rental, Homeless Prevention, Utility Assistance, and Family Support.

    We serve all clients regardless of income, race, religion/creed, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws. The roles and responsibilities of the Client and Counselor are listed below.

  • Client & Counselor Roles & Responsibilities

  • Counselor Roles & Responsibilities

    Client's Roles & Responsibilities

    • Review housing goals and finances. May include income, debt, assets, and credit history
    • Prepares Client Action Plan that list steps to take to acheive your goals
    • Prepare budget to help you manage expenses and savings
    • Your counselor will provide guidance, education, and information in support of your goals
    • Your counselor can provide guidance to goals and access to resources
    • Your counselor will not provide any legal advice in any aspect(s)
    • Complete the steps assigned to complete the goals that is set up
    • Provide accurate information on expenses, income, employment, and other household assets
    • Attend scheduled meetings, return calls, and provide requested information in a timely manner
    • Update your goals with your counselor
    • Complete education workshops/classes (pre-purchase workshop, financial education workshop, etc)
    • For legal inquiries please seek legal advice outside of FHAS
  • Termination of Services: Failure to work or cooperate with your assigned housing counselor will result in the immediate termination and removal of counseling services. This includes missing three (3) scheduled meetings. A FHAS staff employee will make three (3) attempts to contact you before the file is closed. Your file will be reopened if you choose to resume service with FHAS at a later date.
    *   {startDate}      {startDate}
    {email}

  • Family Housing Advisory Services serve all clients regardless of income, race, ethnicity, religion, sex, national origin, age, familial status, disability, and/or sexualgender orientation.

    Disclosure Form 2023

  • Family Housing Advisory Services Program Disclosure

  • Agency Conduct: No FHAS personnel, officer, director, volunteer or agent shall undertake any act that might result in, or create the appearance of, administering counseling operations for personal or private gain, provide preferential treatment for any person, organization, agency, or engage in conduct that will compromise our agency's compliance with federal, state, and local laws & regulations and our committment to serving the best interests of our clients and their families.

    Agency Relationships: FHAS also has financial affiliation with HUD, the City of Omaha and other funders to administer pre-purchase, post-purchase, and financial education and counseling. FHAS also receives education fees from the Federal Home Loan Bank down payment asistance program. As a housing counseling participant, you are not obligated to use any of the products, service, or partners discussed in our workshops, counseling sessions will still be provided. As a client, you are entitled to seek and choose your own real estate professional, lender, and lending products that you qualify for and that best fit your needs. A list of our partner relationships and workbook fees are posted in the classrom, (at select areas).

    Referrals and Community Resources: FHAS can provide a community resource list which outlines services to meet a variety of needs. FHAS staff can provide you with a list of organizations and agencies that provide similar services to those offered by FHAS, outside services might be a cost to you, and such resource list can be found in the lobby of FHAS located at 2401 Lake Street, 2nd Floor Receptionist Area.

    Privacy Policy: Please see our privacy policy statement. FHAS does not share your information without written or verbal consent, any shared information will be in violation of this policy.

    Quality Assurance: To assess client satisfaction, a FHAS Staff Member, Employee, or Intern may contact you during or after the completion of your counseling service. You may be asked to complete a survey to evaluate your client experience with your housing counseling, ease of resource referral, and other experiences throughout your time with FHAS.

    Home Inspection (if applicable): Home inspection materials are provided at the workshop and also during your one-on-one housing counseling.

    I/we acknowledge that I/we received, reviewed, and agree to the Family Housing Advisory Services Program Disclosures.

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  • Primary Applicant Name: {yourName} Co-Applicant Name: {coapplicantName}
    Date: {startDate}

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  • Household Data Survey

    This form is valid for the following workshops: Financial Education, Pre-Purchase, and Post-Purchase.
  • Current Address: {currentAddress}

  • The assistance for which you are applying for is in whole or in part funded by the City of Council Bluffs and the City of Omaha Development Block Grant (CDBG) Program funds. In order to qualify for assistance under the City of Council Bluffs and the City of Omaha CDBG Program, participants must meet certain income qualifications. The City of Council Bluffs and the City of Omaha utilized the Part 5 annual income (as defined in 24 CFR Part 5) to calculate annual [gross] income. The Part 5 definition of annual income is the gross amount of income of all adult household members that is anticipated to be received during the coming 12 month period and includes the following:

    1. The full amount, before any payroll deductions, of wages and salaries, overtime pay, commissions, fees, tips, and bonuses.
    2. Net income from operation of a business or profession, interest, dividends and other net income from real or personal property (requires asset calculation).
    3. Income from assets such as: amounts in savings and checking accounts, retirement savings accounts, and cash value of life insurance policies (If less than $5,000 in assets utilize actual income from assets. If assets are more than $5,000, then calculate asset income utilizing a 3% passbook rate).
    4. Full amount of periodic amounts received from Social Security, annuities, insurance policies, retirement funds, pensions, disability or death benefits, regular pay, special pay and allowances of a member of the Armed Forces.
    5. Payments in lieu of earnings (unemployment, disability compensation, worker's compensation and severance pay) and government assistance and other need-based payments to families or individuals, periodic and determinable allowances (alimony, child support payments, regular contributions or gifts).

    Please complete the following Anticipated Annual Income table to the best of your ability. *Please note, family member names on the left will be added by your counselor after this form has been submitted*

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  • Once the Annual Income is calculated, please find your Household Size below and select the appropriate box based off of your Annual Income:

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  • I hereby certify that the information I have provided is complete and accurate to the best of my knowledge.

    I acknowledge information gathered to demonstrate eligibility to participate in the program shall be made available to the City of Council Bluffs and the City of Omaha, or its agents and/or the U.S. Department of Housing and Urban Development (HUD), or its agents, or other authorized federal officials for purposes of investigation to ascertain compliance with the rules, regulations, and provisions of the CDBG Program.

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  • Applicant Name: {yourName} Co-Applicant Name: {coapplicantName}
    Date: {startDate}

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  • US Citizenship Attestation Form for Public Benefit

    This form is valid for the following workshops: Financial Education, Pre-Purchase, and Post-Purchase.
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  • Client Assessment

  • Section 1: Financial Knowledge

  • Section 2: Financial Behavior

  • Section 3: Financial Challenges in the Last 6 Months

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  • Financial Education - Pre-workshop Test

  • The purpose of the Pre-workshop Test(s) is to measure the effectiveness of our training. You will be asked the same set of questions before and after the training, to see whether your understanding and knowledge have increased as a result of this training. You will not receive a grade or pass/fail mark for how you answer these questions. Please answer the questions to the best of your knowledge.

     

    For each of the following questions, please select the best choice:

  • Applicant Name: {yourName} Today's Date: {startDate}

  • #16. The Equal Credit Opportunity Act prohibits lenders from discrimination. Name three (3) factors a lender cannot consider in deciding whether to give credit (currently 8 protected classes): 
             

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  • Homebuyer Pre-Test

  • Applicant Name: {yourName} Today's Date: {startDate}

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