NID Housing Counseling Agency Mortgage Assistance Application

	Amount
Mortgage
Savings (monthly contribution)
Utility - Gas
Utility - Electricity
Utility - Water-Trash
Utility - Cable-Internet-TV
Phone - Cell - Landline
Auto Car Payment
Auto Gas
Auto Insurance
Public Transportation
Life Insurance
Household Groceries
Dining Out
Laundry - Cleaning - Hygiene Products
Credit Cards (minimum payment)
Tuition - Student Loan - Books
Personal Loan
Bankruptcy Payment
Child Support
Child Care
Health Care
Church Contributions - Donations
Other - Personal
TOTAL HOUSEHOLD EXPENSES

Policies and Disclosures

Please read through and initial or sign where applicable
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Credit Report Authorization and Privacy Disclosure Form

I hereby authorize and instruct NID-Housing Counseling Agency hereinafter to obtain and review my credit report. My credit report will be obtained from a credit-reporting agency chosen by NID-HCA. I understand and agree that NID-HCA intends to use the credit report to evaluating my financial readiness to purchase a home, credit counseling and or to engage in post-purchase counseling.
My signature below also authorizes the release to credit reporting agencies of financial or other information that I have supplied to NID-HCA in collection with such evaluation. Authorization is further granted to the credit-reporting agency to use a copy of this form to obtain any information the credit reporting agency deems necessary to complete my credit report.
In addition, in connection to determine my ability a loan:
I First Name Last Name
Check one authorize Check one do not authorize
NID-HCA to share with potential mortgage lenders and or counseling agencies my credit report and any information that I have provided, including any communication and computations and assessments that have been produced based upon such information. These lenders may contact me to discuss loans for which I may be eligible, and these counseling agencies may contact me to discuss counseling services.
I understand I may revoke my consent to these disclosures by notifying NID-HCA National Office in writing.
Today’s Date

MonthDayYear
Date
Name*

First NameLast Name
Date of Birth
Social Security Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Signature*

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Third Party Authorization Form

Please fill in the blanks
I hereby authorize    Mortgage/Lender Company*  to discuss my request for payment assistance with the following individual(s): Lawrence Batiste, Audrey Milam who work for NID-Batiste Atlanta Metro a housing counseling service (hereinafter the "Designated Agent").
Further,   Mortgage/Lender Company*   is hereby authorized to negotiate the terms of a workout agreement with my Designated Agent and to deliver documents to my Designated Agent which concern my request for payment assistance.
I understand that I will be fully responsible for reviewing any information that is sent by   Mortgage/Lender Company*   to my Designated Agent. This Authorization will remain effective until I specifically notify   Mortgage/Lender Company*   Workout Department in writing that this Authorization is of no further force and effect.

Property Address:   Address*
Date*

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Date
Name*

First NameLast Name
Signature*

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Co-Borrower Name

First NameLast Name
Co-Borrower Signature

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Schedule One-On-One Counseling Session

Choose date and time below for counseling session with Mr. Lawrence Batiste.
Should be Empty:

Supporting Documents Needed to Complete Application.

Counseling Plan and Alternatives

Applicant Information

NID Atlanta Metro Regional

Monthly Household Budget

Mortgage Details

Policies and Disclosures

Third Party Authorization Form

Schedule One-On-One Counseling Session