SustainHome Academy Application

Full Name:

Date of Birth:

Phone:

Email Address:

Current Address:

City:

State:

Zip Code:

Total Household Members:

Number of Dependents:

Are there Veterans in the household?

Are there individuals with disabilities in the household?

Are there Seniors (62+) in the household?

Total Household Income per Month/Year:

Source(s) of Income (Check all that apply)

If other, please specify:

Property Address (if different from above):

Lender Name:

Current Mortgage Status:

Have you received any foreclosure notices?

Have you previously applied for mortgage assistance?

If yes, what was the outcome?

Please check all that apply

If other, please specify:

The goal of the SustainHome Academy is to help at-risk homeowners get back in good standing and to build sustainability. All clients must fulfill all components of the SustainHome Aacademy program in order to receive a certificate of completion and future Assistance. The components include, but are not limited to, the following:

Foreclosure Prevention Counseling
Financial Literacy/Budgeting Sessions
Post Purchase Education
Legal Counseling/Estate Planning Session

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false informationmay result in disqualification from the SustainHome Academy program. I authorize NHDC to verify the information provided and to share the necessary details with partenr organizations for the purpose of securing assistance.

Signature

Date Received:

Reviewed By:

Eligibility Determination:

Reason for Determination:

Next Steps Referrals:

Notes:

SustainHome Academy Application

Section 1: Applicant Information

Section 2: Household Information

Section 3: Income Information

Section 4: Home & Mortgage Information

Section 5: Reason for Financial Hardship:

Section 6: Agreement and Certification:

For Office Use Only: