Miracle on Britton Application

Applicant

First Name

Last Name

Email*

Home Phone

Mobile Phone

Work Phone

Preferred Phone

Mailing Address

Date Moved to address

Date of Birth

Primary Language

Marital Status

Gender

Race

Ethnicity

Educational Attainment

Employment Status

Co-Applicant

First Name

Last Name

Date of Birth

Phone

Gender

Race

Ethnicity

Educational Attainment

Employment Status

Additional Household Member #1

First Name

Last Name

Date of Birth

Gender

Race

Ethnicity

Is this person a dependent of the Applicant and/or Co-Applicant?

Does this person live in the house more than 50% of the time?

Additional Household Member #2

First Name

Last Name

Date of Birth

Gender

Race

Ethnicity

Is this person a dependent of the Applicant and/or Co-Applicant?

Does this person live in the house more than 50% of the time?

Additional Household Member #3

First Name

Last Name

Date of Birth

Gender

Race

Ethnicity

Is this person a dependent of the Applicant and/or Co-Applicant?

Does this person live in the house more than 50% of the time?

Additional Household Member #4

First Name

Last Name

Date of Birth

Gender

Race

Ethnicity

Is this person a dependent of the Applicant and/or Co-Applicant?

Does this person live in the house more than 50% of the time?

Additional Household Member #5

First Name

Last Name

Date of Birth

Gender

Race

Ethnicity

Is this person a dependent of the Applicant and/or Co-Applicant?

Does this person live in the house more than 50% of the time?

Financial History

How many times have you been late with your bill payments in the last year?

How much do you typically pay on your monthly credit card bill?

If you have been involved in the foreclosure process, what was the date of your first notice of foreclosure?

Does not Apply

If you've declared bankruptcy in the past 7 years, what was the date of your bankruptcy discharge?

Does not Apply

Assets

Please list the current the value of all household Assets. Please enter numbers without dollar signs.

Checking Accounts:

Savings Accounts:

Retirement Accounts:

Investments:

Real Estate:

CDs (Certificate of Deposit):

Other:

Debts

Please list all household Debts. Please enter numbers without dollar signs.

Credit Cards:

Education Loans:

What best describes your current living situation?

How many bedrooms are in your current home?

Current Monthly Rent:

Monthly Utilities (gas, water, electricity, etc.):

Please describe any special needs or accommodations required by your household. For example, "one level only" or "at least one ADA-accessible bathroom required."

Homeownership Goals

Will you be a first-time homebuyer?

What is your primary reason for wanting to purchase a home?

Which of the following are barriers to buying a home?

In how many months do you expect to be financially ready to purchase a home?

How much do you currently have saved specifically for buying a home (down payment, closing costs, etc.)?

What is most important to you about the neighborhood in which you purchase a home? Choose your top 3.

How many bedrooms would you like in your new home?

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Print Form

Miracle on Britton

Applicant

Co-Applicant

Additional Household Member #1

Additional Household Member #2

Additional Household Member #3

Additional Household Member #4

Additional Household Member #5

Financial History

Assets

Debts

Employment / Income Source Information

Income Source #1

Income Source #2

Income Source #3

Income Source #4

Income Source #5

Current Living Situation

Homeownership Goals

The Problem

Our Solutions