Rental Counseling Waitlist Form

Rental Counseling Waitlist

SNHS is booked out until September for Rental Counseling sessions. Please fill out this form to be added to our waitlist for when appointments reopen for Rental Counseling.
Applicant Name*

First NameMiddle NameLast Name
Applicant Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email*
example@example.com
What county do you live in?*
County
Address*

Street Address

apt #

CityState

Zip Code

Housing Counseling Disclosure

Please read the disclosure in it's entirety.
Services Offered:
NeighborWorks® HomeOwnership Center Sacramento Region offers the following HUD one-on-one counseling and group education services: Pre-Purchase Counseling, Foreclosure Prevention Counseling, Rental Counseling, Non-Delinquent Post-Purchase Counseling, Preparing for HomeOwnership Workshops, and Financial Capability Classes. See the first Addendum, “HomeOwnership Center Services,” for a full description of our services.

Privacy Statement:
NeighborWorks® HomeOwnership Center Sacramento Region values your privacy. When you use our service, we collect personal information in order to provide the services you requested and to support our housing counseling program. We collect the following information: information we receive from your application and other forms, information about your transactions with us, our affiliates, or others, and information we receive from a consumer reporting agency. Our agency takes precautions to keep your information confidential and secure per HUD requirements. NeighborWorks® HomeOwnership Center Sacramento Region may not use or disclose the information provided by you without written consent except under the following circumstances: as necessary to provide the services you request, as required by law or in response to a subpoena or search warrant, or to outside auditors such as HUD or NeighborWorks® America who have agreed to keep the information confidential.

Relationships with Industry Partners:
NeighborWorks® HomeOwnership Center has financial relationships with several partners in the industries of lending, real estate, insurance, and other related fields. See the Addendum “Financial Partnerships” for a list of partnering organizations.

No Client Obligation:
There is no obligation to receive, purchase, or use any product or service offered by this agency or any services of its industry partners or another party in exchange for your receiving HUD housing counseling and/or education services.

Alternatives:
As a condition of our services and in compliance with HUD’s Housing Counseling Program requirements, we may provide information on alternative services, programs, and products available to you.
Acknowledgments
Please initial that you have read and understand the following acknowledgments:

1. I understand that NeighborWorks Sacramento receives Congressional funds for housing counseling. As such, it is required to submit client-level information through the online reporting system with program administrators or their agents for program monitoring, compliance, and evaluation.

2. I may be referred to other housing services or agencies as appropriate to able to assist with concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.

3. I can “opt-out” of disclosures of my non-public personal information to third parties (such as your creditors).

4. By submitting my contact information, I authorize NeighborWorks Sacramento to contact me by, phone, email, and/or by mail.

By intialing below I chose to opt-out of disclosures of my non-public personal information to third parites (such as your creditors)
Applicant Initials
Co-Applicant Initials
If I choose to “opt-out,” NeighborWorks Sacramento will not be able to answer questions from my creditors. If at any time, I wish to change my decision regarding my “opt-out” choice, I may call 916-452-5356 and do so.

Third-Party Release Information

1. So long as you have not opted out, NeighborWorks Sacramento may disclose some or all of the information that we collect, as described above, to creditors, where we have determined that it would be helpful to you, would aid us in counseling you, or is a requirement for grant awards.

2. We may also disclose any nonpublic personal information about you as permitted by law (e.g., if we are compelled by legal process).

3. Within the organization, we restrict access to nonpublic personal information about you to those employees who need to know that information to provide services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

I acknowledge the above and have received a copy of NeighborWorks Sacramento’s privacy policy.
Applicant Name*

First NameLast Name
Applicant Signature*

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Date Signed

MonthDayYear
Date
Co-Applicant Name

First NameLast Name
Co-Applicant Signature

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Date Signed

MonthDayYear
Date

Rental Counseling Waitlist

Housing Counseling Disclosure

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