Foreclosure Prevention Intake Form

- Current Employment Status:
  
  Other
- Most Recent Employer:
- Employer's Phone:
  Please enter a valid phone number.Format: (000) 000-0000.
- Employment Start Date:
  
  MonthDayYear
  Date
- Employment End Date:
  
  MonthDayYear
  Date - Do not include a date if currently employed
- Most Recent Employer's Address:
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- Previous Employer:
- Employer's Phone:
  Please enter a valid phone number.Format: (000) 000-0000.
- Employment Start Date:
  
  MonthDayYear
  Date
- Employment End Date:
  
  MonthDayYear
  Date - Do not include a date if currently employed
- Previous Employer's Address:
  
  Address
  
  Street Address Line 2
  
  City StateState
  
  Zip

- {coapplicantFirst} {coapplicantLast}'s Current Employment Status
  
  Other
- {coapplicantFirst} {coapplicantLast}'s Most Recent Employer:
- Employer's Phone:
  Please enter a valid phone number.Format: (000) 000-0000.
- Employment Start Date:
  
  MonthDayYear
  Date
- Employment End Date:
  
  MonthDayYear
  Date - Do not include a date if currently employed
- {coapplicantFirst} {coapplicantLast}'s Most Recent Employer's Address:
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- {coapplicantFirst} {coapplicantLast}'s Previous Employer:
- Employer's Phone:
  Please enter a valid phone number.Format: (000) 000-0000.
- Employment Start Date:
  
  MonthDayYear
  Date
- Employment End Date:
  
  MonthDayYear
  Date - Do not include a date if currently employed
- {coapplicantFirst} {coapplicantLast}'s Previous Employer's Address:
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip

Rows	First Mortgage	Second Mortgage
Have you previously applied for a loan modification or forbearance? (Answer: Yes or No)
If yes, please provide details on the outcome of your previous foreclosure prevention effort:

Since you've indicated that you are married, separated, or have another person listed on your mortgage or deed, please answer the next couple of questions based on INDIVIDUAL contributions.

Please provide information regarding YOUR income and household debts and expenses below. Remember, every number should represent a monthly calculation (not quarterly or annual).

Rows	Gross (Before Taxes/Deductions)	Net (After Taxes/Deductions)
Salary/wage earnings
Rental Income
Child Support/Alimony
Social Security
Pension Income
Dependent SSI Income
Disability Income
Unemployment Income
Public Assistance Income
Other
Total

Total COMBINED Gross:
Total COMBINED Net:

YOUR Average Monthly Budget

Rows	Amount
Rent or Mortgage
Property Taxes, HOA, Insurance
Car Payment
Car Insurance
Credit Card(s)
Child care/daycare
Alimony/Child Support
School Tuition
Medical debt
Gas/Transportation
Household Utilities
Cell phone (s)
Food (groceries + eating out)
Student Loan debt
Tithing
Other:
Total:

Total COMBINED costs:
Total COMBINED costs:
Equals
Your monthly cash flow is:
Please provide information regarding your TOTAL COMBINED income and household debts and expenses below. Remember, every number should represent a monthly calculation (not quarterly or annual).

Rows	{coapplicantFirst} {coapplicantLast}'s Amount
Rent or Mortgage
Property Taxes, HOA, Insurance
Car Payment
Car Insurance
Credit Card(s)
Child care/daycare
Alimony/Child Support
School Tuition
Medical debt
Gas/Transportation
Household Utilities
Cell phone (s)
Food (groceries + eating out)
Student Loan debt
Tithing
Other:
Total:

Assets

Rows	Total Value, Liquid Assets:
Checking Account
Savings Account
Stocks/bonds/CDs
Other
Total Value

Assets

Rows	Total Value, Hard Assets:
Investment Property Value
Owner Occupied Property
Other:
Total Value

Name 1 Signature
Date

MonthDayYear
Date
Name 2 Signature
Date

MonthDayYear
Date

- DISCLOSURE STATEMENT
  
  Program Disclosure Form
  
  _________________________________________________________________________________________
  
  Oasis of Hope Community Development Corp. (Oasis of Hope CDC) is a non-profit, HUD approved housing counseling agency. We serve all clients regardless of income, race, color, religion, sex, 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, including the federal Fair Housing Act (42 USC 3600, ETSeq)
  
  Agency Relationships: Oasis of Hope CDC has financial affiliations (if funded by HUD) or professional affiliations (if funded by HUD) with HUD, Neighbor Works America, USDA Rural Development, the State of Illinois, Smith County, and Banks including Bank of America, Wells Fargo, JP Morgan Chase, BB&T now Truist, Total Bank, Valley National Bank, and Florida Counseling Programs. As a housing counseling program participant, you are not obligated to use the products and services of Oasis of Hope CDC or our industry partners.
  
  Oasis of Hope CDC offers three different group workshops and one homeownership education class that you can complete at your own pace. We also offer four different types of counseling programs.
  - Pre-Purchase Homebuyer Education Workshop & Inspection Materials /$00.00 per person:
    
    Group homebuyer education class to help clients achieve goal of homeownership.
  - Pre-Purchase Homeownership Counseling & Inspection Materials /$169.00 per person or couple:
    
    Preparing for Home Purchase
  - Post-Purchase Homeownership Counseling /$00.00 per person or couple:
    
    Post-purchase counseling designed to empower homeowners with the knowledge and skills necessary to maintain and sustain their homes, avoid foreclosure, and achieve long-term financial stability.
  - Financial Budgeting and Credit Workshop & Inspection Materials /$00.00 per person:
    
    Group Budgeting & Improving Credit
  - Financial Management/Budget Counseling & Inspection Materials /$00.00 per person:
    
    One-On-One Budgeting & Improving Credit
  - Mortgage Delinquency & Default Resolution Counseling & Inspection Materials /$00.00 per person:
    
    Mortgage Assistance
  - E-Home America Homebuyer Education Online Class & Inspection Materials /$99.00
    
    Online class. Clients can access this link https://www.ehomeamerica.org/oasiscdc and complete the required 8-hour course online.
  - Rental Housing Counseling & Inspection Materials/$00.00 per person:
    
    Housing counseling and rental assistance. This service is designed to match client housing needs with other locally available housing projects and programs.
  - Rental Housing Workshop/$00.00 per person: (Rental Assistance and Preventive Rental Eviction Financial Literacy)
    
    Group classes are monthly classes for renters that are facing eviction from the loss or a reduction of household family income and cannot meet the needs of paying their rent.
  ***Language / Sign Language Interpreters are available upon 72 hours written request. Request forms can be obtained from a housing counselor.
  
  **Policy/Procedure for a Reduction of Fee or Waiver of Fee: Clients must demonstrate financial need to qualify based on financial analysis and other relevant financial information and mortgage readiness. Clients may submit a written request to the assigned HUD Certified housing counselor with an explanation of hardship and any supporting documentation. The request will be reviewed by the executive director and decision/notification will be provided to client within 5 business days. In cases of extreme financial hardship, the executive director may consider referring a client to our free financial management and budget counseling services.
- I/We understand that it is my/our right and responsibility to decide whether to engage in any course of housing counseling with Oasis of Hope CDC and determine whether counseling is suitable for my/our housing problem.
  
  I/We understand that we are not obligated to receive, purchase or utilize any other services offered byOasis of Hope CDC, or its exclusive partners, in order to receive housing counseling.
  
  I/We understand that Oasis of Hope CDC has the discretion to charge reasonable fees for somecounseling services, and that these fees will be explained to me prior to any counseling. I furtherunderstand that fees will not be charged if they create a financial hardship and that I will not be deniedcounseling if I cannot pay the fees.
  
  I/We understand that Oasis of Hope CDC provides information on a broad range of housing programsand products and that the housing counseling I receive from Oasis of Hope CDC in no way obligates meto choose any particular loan product or housing program discussed in my counseling sessions.
  
  I/We understand that Oasis of Hope CDC does not guarantee that I/We will receive mortgage financingfrom any lender and/or other mortgage financing entity.
  
  I/We may be referred to other housing services of the organization or to another agency or agencies asappropriate that may be able to assist with particular concerns that have been identified. I understandthat I am not obligated to use any or the services offered to me.
  
  I/We understand that a counselor may answer questions and provide information but cannot give legaladvice. If I want legal advice, I will be referred for appropriate assistance.
  
  I/We acknowledge that I/we received, reviewed, understand and agree to Oasis of Hope CDC Counseling Services Disclosure Statement.
- Client Signature
- Date
  
  MonthDayYear
  Date
- Print Name
- Counselor Signature
- Date
  
  MonthDayYear
  Date
- Print Name
- Telephone Counseling: Disclosure State Read to client? (Internal Use Only)

Oasis of Hope CDC 600 SW 3rd St. Suite 2290, Pompano Beach FL 33060 Phone (954) 586-1283 Fax (954) 951-6239 www.oasiscdc.org
Third Party Authorization
NOTE: If you have impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about housing counseling, please talk to your housing counselor about arranging alternative accommodations.
Counselor
Counselor Agency
You hereby authorize and instruct Oasis of Hope Community Development Corporation and/or its assigned agents to:
- Obtain and review your credit report, and
- Request verifications of your income and rental history, and any other information deemed necessary for improving your housing situation (for example, verifying your annual property tax obligations and homeowner's insurance fees)
Your credit report will be obtained from a credit reporting agency chosen by Oasis of Hope CDC. You understand and agree that Oasis of Hope CDC intends to use the credit report for the purpose of evaluating your financial readiness to purchase or rent a home and/or to engage in post-purchase counseling activities. You hereby authorize Oasis of Hope CDC to share your credit report and any information that you provided (including any computations and assessments produced) with the entities listed below in order to help Oasis of Hope CDC determine your viable financial options.
- Lenders
- Debt Collectors
- Property Management Companies
- Banks
- Landlords
- Mortgage Servicers
- Public Housing Authorities
- Counseling Agencies
I understand that Oasis of Hope CDC submits client-level information relating to the Project Reinvest: Financial Capability grant to the Neighbor Works America Data Collection System (DCS), opens files to be reviewed for program monitoring and compliance purposes, and conducts follow-up with clients related to program evaluation. I give permission for Project Reinvest: Financial Capability program administrators and/or their agents to follow-up with me within the next three years for the purposes of program evaluation.

Entities such as mortgage lenders and/or counseling agencies may contact your Oasis of Hope CDC counselor to evaluate the options for which you may be eligible. In connection with such evaluation, you authorize the credit reporting and/or financial agencies to release information and cooperate with your Oasis of Hope CDC counselor. No information will be discussed about you with entities not directly involved in your efforts to improve your housing situation.

You hereby authorize the release of your information to program monitoring organizations of Oasis of Hope CDC, including but not limited to, Federal, State, and nonprofit partners for program review, monitoring, auditing, research, and/or oversight purposes. In addition you authorize Oasis of Hope CDC to have your credit report pulled two additional times to conduct program evaluations. You also agree to keep Oasis of Hope CDC informed of any changes in address, telephone number, job status, marital status, or other conditions which may affect your eligibility for a program you have applied for or a counseling service that you are seeking.

Finally, you understand that you may revoke consent to these disclosures by notifying Oasis of Hope CDC in writing.
Signature
Print Name
Date

MonthDayYear
Date

Exhibit A

CONSUMER AUTHORIZTION AND RELEASE
I hereby authorize CoreLogic Credco, LLC ("CREDCO" or "FAC") to obtain my consumer report/credit information, credit risk scores and other enhancements to my consumer report (hereinafter collectively referred to as "Report") from one or more of the three national credit repositories (Equifax, Experian, Trans Union) and provide a copy of the Report to my housing counseling agency, OASIS OF HOPE CDC INC ("Counselor) for Counselor to provide housing counseling services. This authorization is intended to comply with a consumer report request as set forth in 15 U.S.C. 1681b(a)(2).

I acknowledge that the Report is provided "AS IS" AND THAT CREDCO MAKES NO REPRESENTATION OR WARRANTY, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE AND IMPLIED WARRANTIES ARISING FROM A COURSE OF DEALING OR A COURSE OF PERFORMANCE WITH RESPECT TO THE ACCURACY, VALIDITY, OR COMPLETENESS OF THE REPORT OR THAT IT WILL MEET MY NEEDS AND CREDCO EXPRESSLY DISCLAIMS ALL SUCH REPRESENTATIONS AND WARRANTIES.

I recognize that the accuracy, validity or completeness of the Report provided by CREDCO is not guaranteed by CREDCO and I hereby release CREDCO and CREDCO's parent, sister, affiliated companies, successors and assigns and its and their directors, officers, agents, employees and independent contractors (collectively, "CREDCO's Affiliates") from any liability for any negligence in connection with the preparation of the Report and from any loss, damages, expenses, costs or obligations of any kind and nature whatsoever suffered by me resulting directly or indirectly from the inaccuracy, invalidity or incompleteness of the Report.

I covenant not to sue or maintain any claim, cause of action, demand, cross action, counterclaim, third party actionor other form of pleading against CREDCO or CREDCO's Affiliates for damages based upon the inaccuracy, invalidity or incompleteness of any Report provided by CREDCO hereunder.

If one or more of the provisions, or a portion of a provision of this document are held for any reason to be invalid, illegal or unenforceable, such invalidity or illegality or unenforceability will not affect any other provisions of this document, and this document will be construed as if such invalid, illegal or unenforceable provision had not been contained herein.
Client Signature
Date

MonthDayYear
Date
Print Name
SS#
Client Signature
Date

MonthDayYear
Date
Print Name
SS#

OASIS OF HOPE CDC

600 SW 3rd St. Suite 2290, Pompano Beach FL 33060 Phone (954) 586-1283 Fax (954) 951-6239 www.oasiscdc.org
Program Disclosure Form and Partnership Disclosure List
Please be advised that if Oasis of Hope does not have the capabilities to assist you, we will provide you with a pamphlet of resources that we have partnered and developed a relationship that may be beneficial to your needs. We hope we are able to assist you.

Agency Relationships: Oasis of Hope CDC has financial affiliation (if funded by HUD) or professional affiliations (if not funded by HUD) with HUD, 211, NeighborWorks America, USDA Rural Development, and banks including Bank of America, Wells Fargo, BB&T, TD Bank, Valley Bank, Iberia Bank, City National, and JP Morgan Chase. As a housing counseling program participant, you are not obligated to use the products and services of Oasis of Hope CDC or our industry partners.

Family Success Center is in four locations within Broward County:

Monday - Friday 8:30am - 5pm

(954) 357-5099

Broward.org/Family

North - Pompano Beach

Northwest - Coral Springs

South - West Park

Central - Edgar P. Mills Multi-Purpose Center
Signature
Date

MonthDayYear
Date
Signature
Date

MonthDayYear
Date

TEN IMPORTANT QUESTIONS TO ASK YOUR HOME INSPECTOR

1. What does your inspection cover?

The inspector should ensure that their inspection and inspection report will meet all applicable requirements in your state if applicable and will comply with a well-recognized standard of practice and code of ethics. You should be able to request and see a copy of these items ahead of time and ask any questions you may have. If there are any areas you want to make sure are inspected, be sure to identify them upfront.

2. How long have you been practicing in the home inspection profession and how many inspections have you completed?

The inspector should be able to provide his or her history in the profession and perhaps even a few names as referrals. Newer inspectors can be very qualified, and many work with a partner or have access to more experienced inspectors to assist them in the inspection.

3. Are you specifically experienced in residential inspection?

Related experience in construction or engineering is helpful, but is no substitute for training and experience in the unique discipline of home inspection. If the inspection is for a commercial property, then this should be asked about as well.

4. Do you offer to do repairs or improvements based on the inspection?

Some inspector associations and state regulations allow the inspector to perform repair work on problems uncovered in the inspection. Other associations and regulations strictly forbid this as a conflict of interest.

5. How long will the inspection take?

The average on-site inspection time for a single inspector is two to three hours for a typical single-family house; anything significantly less may not be enough time to perform a thorough inspection. Additional inspectors may be brought in for very large properties and buildings.

6. How much will it cost?

Costs vary dramatically, depending on the region, size and age of the house, scope of services and other factors. A typical range might be $300-$500, but consider the value of the home inspection in terms of the investment being made. Cost does not necessarily reflect quality. HUD Does not regulate home inspection fees.

7. What type of inspection report do you provide and how long will it take to receive the report?

Ask to see samples and determine whether or not you can understand the inspector's reporting style and if the time parameters fulfill your needs. Most inspectors provide their full report within 24 hours of the inspection.

8. Will I be able to attend the inspection?

This is a valuable educational opportunity, and an inspector's refusal to allow this should raise a red flag. Never pass up this opportunity to see your prospective home through the eyes of an expert.

9. Do you maintain membership in a professional home inspector association?

There are many state and national associations for home inspectors. Request to see their membership ID, and perform whatever due diligence you deem appropriate.

10. Do you participate in continuing education programs to keep your expertise up to date?

One can never know it all, and the inspector's commitment to continuing education is a good measure of his or her professionalism and service to the consumer. This is especially important in cases where the home is much older or includes unique elements requiring additional or updated training.
Client 1 Signature
Date

MonthDayYear
Date
Client 2 Signature
Date

MonthDayYear
Date
https://www.hud.gov/program_offices/housing/sfh/insp/inspfaq

Rows	First Mortgage	Second Mortgage
Mortgage Servicer Name
Loan Number
Loan Balance
Interest Rate
Monthly Principal and Interest Payment (excluding taxes & insurance)
Private Mortgage Insurance (PMI) payment
Do you have a Fixed or Adjustable Rate?
Date of your last payment
Past Due Amount

Rows	Completely	Very Well	Somewhat	Very little	Not at all
1. I could handle a major unexpected expense.
2. I am securing my financial future.
3. Because of my money situation, I feel like I will never have the things I want in life.
4. I can enjoy life because of the way I'm managing my money
5. I am just getting by financially.
6. I am concerned that the money I have or will save won't last.

Rows	Always	Often	Sometimes	Rarely	Never
7. Giving a gift for a wedding, birthday or other occasion would put a strain on my finances for the month
8. I have money left over at the end of the month.
9. I am behind with my finances.
10. My finances control my life.

Foreclosure Prevention Client Intake Form

Third Party Authorization

Exhibit A

OASIS OF HOPE CDC

Program Disclosure Form and Partnership Disclosure List

CFPB FINANCIAL WELL-BEING SCALE

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