Rental Counseling Services APPLICATION FOR SERVICE

Transcription

1 DURHAM REGIONAL FINANCIAL CENTER Rental Counseling Services APPLICATION FOR SERVICE Appointments Fax

2 Welcome Welcome to Durham Regional Financial Center (DRFC), we appreciate your expressed interest and selecting DRFC as your service provider. We are a HUD approved 501(c)3 housing counseling agency that provides a comprehensive portfolio of services and programs to our clients, and our HUD-certified housing counselors have undergone rigorous trainings to acquire their respect certifications. While technical expertise is obviously paramount to educating and assisting our customers, we have not lost sight of the importance of compassion, encouragement, and support along with providing hope to a client base who can be fearful, and often embarrassed, about their financial situations. Our professional staff understands that and treats every individual with respect, courtesy, and professionalism. Our counselors and other staff members possess a rare combination of hard and soft skills, which allow us to maximize the positive impact we have in educating and supporting our customers. We look forward to working with you as we begin this journey of accomplishments. Cordially, Durham Regional Financial Center Management and Staff Rental Counseling The primary objective of the Durham Regional Financial Center s rental counseling program is to educate families and individuals in order to help them make educated decisions regarding improving their housing situations and meeting the responsibilities of tenancy and/or homeownership. The DRFC housing counselor will discuss with clients: (1) Financial management; (ii) Property maintenance; (iii) Responsibilities of homeownership and tenancy; (iv) Fair housing laws and requirements; (v) Housing affordability; (vi) Avoidance of, and response to, rental or mortgage delinquency and avoidance of eviction or mortgage default; and (vii) Help to identify an affordable property suitable for your needs.

3 Durham Regional Financial Center Financial Empowerment Center & Homeownership Center 2634 Durham-Chapel Hill Blvd ~ Suite 212 ~ Durham, NC Voice: / Fax: Website: Client Intake Information This form allows us to collect information needed to serve you. Please provide all information requested so that we are better prepared to expedite your request for service. Please attach a copy of your driver s license. How did you hear about this Agency Today s Date Name Spouse/Cohabitant Name: Address: Home Phone: Cell Phone: City/State/Zip County SS# Race Sex Age Martial Status: Single Married Divorced Widowed DOB Driver s License# Other s Living in Household: Relationship Age DOB Sex Race Employment Applicant Employer Co-Applicant Employer Position: Position: Address: Address: City/State/Zip City/State/Zip Phone: Phone: Start Date: Hrs. Per Wk Start Date: Hrs. Per Wk Monthly Gross Income:_$ Monthly Gross Income:$ Other Source of Income: Other Sources of Income: How Much Per Month:_$ How Much Per Month:$ 1. DISCLAIMER AND LIMITATION OF LIABILITY You understand and agree that all services included herein are provided for informational purposes only. By signing the agreement, you authorize DRFC to deliver autodialed, pre-recorded and/or text marketing messages to a designated phone number; and understand that you are not required to sign the agreement or agree to enter into it as a condition of purchasing any property, goods or services. You understand that you may turn on or off our text alerts at any time by replying to the text message STOP, and that any use on your part is solely at your discretion. DRFC reserves the right at any time, in its sole discretion, to refuse to include on the service or remove from the service any user as DRFC deems necessary without cause. DRFC assumes no responsibility or liability for the timeliness, deletion, mis-delivery, the suitability, functionality, availability or operation of this service, or the veracity, accuracy, currency, adequacy, completeness, or usefulness of the service. DRFC makes no warranty that (A) the service is compatible with your equipment, (B) the service will meet your requirements, (C) the service will be uninterrupted, timely, secure or error-free, or (D) the results that may be obtained from the use of the service will be true, complete, accurate or reliable. You will be solely responsible for any damage to your equipment by virtue of your use of the service. Standard text messaging rates may apply through your service provider I UNDERSTAND THAT RECORDING OR FILMING THE SESSION OR PRESENTATION IS NOT PERMITTED Signed Date Signed Date

4 Durham Regional Financial Center 2634 Durham-Chapel Hill Blvd ~ Suite 212 ~ Durham, NC Voice: / Fax: Privacy Policy Durham Regional Financial Center (DRFC) is committed to assuring the privacy of individuals/families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both personal information such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be proved to creditors, program monitors and others only with your authorization and signature. We may also use anonymous aggregated case file information for the purpose of evaluation of our services, gathering valuable research information and designing future programs. Types Of Information We Gather About You Information we receive from you orally, on applications or other forms such as your name, address, social security number, assets and income. Information about your transaction with us, your creditors, or others, such as your account balance, payment history, parties to transactions and credit card usage. Information we receive from credit reporting agency, such as credit history. You May Opt-Out of Certain Disclosures You have the opportunity to opt-out of disclosure of your nonpublic personal information to third parties (such as your creditors) that is, direct us not to disclose. If you choose to opt-out, we will not be able to ask questions from your creditors. If at any time, you wish to change your decisions with regard to your opt-out you may call us at and do so. Release of Your Information to Third Parties So long as you haven t opt-out we may disclose some or all of the information that we collect, as described above, to your creditors or third parties where we have determined that would be helpful to you, would aid us in counseling you, or is a requirement of grant awards which makes our service possible. We may also disclose any non public personal information about you or former customer to anyone as permitted by law (e.g. if we are compelled by legal process) Within the organization, we restrict access to non public 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 with regard your non public personal information. ACKNOWLEDGEMENT: NAME NAME SIGNATURE DATE SIGNATURE DATE

5 Property Needs I am interested in locating: temporary housing permanent housing I would prefer to live in: apartment single family residence multi-family dwelling I will need: one bedroom two bedrooms three bedrooms four bedrooms one bathroom two bathrooms I have special needs: wheelchair ramp Other Needs: (please specify) Affordability Primary Income: Second Income: Other Income: $ $ $ Total Income: $ X 31% = $ Gross Monthly Income Monthly Lease Payment Estimated Monthly Utilities: Electric Gas Water Other $ $ $ $ Total Housing Expense: $ For Office Use Only Credit Score: Security Deposit $

6 Gross Monthly Income #1 $ Gross Monthly Income #2 $ Other Monthly Income $ Total Household Monthly Income $ Monthly Living Expenses Estimates Actuals Other Rent or Mortgage Payment Mortgage Paid To: Second Mortgage Renter/Homeowner Insurance 2 nd Mortgage Paid To: Car Payment #1 Car Payment #2 Delinquent Rent/Mortgage? Child Care Yes No Child Support Type of Mortgage Loan Total Fixed Expenses $ $ Conventional FHA VA Church/Charity Groceries Meals Out/School Lunches Savings Electricity/Oil/Gas Vehicle Information #1 Water/Sewage/Garbage Make Model Telephone/Mobile/Beeper Family Clothing Dry Cleaning/Laundry Condition Good Fair Poor Gasoline/Travel Vehicle Information #2 School Tuition/Supplies Make Model Allowances Barber/Beauty Shop Condition Books/Newspaper/Entertainment/Gifts Good Fair Poor Medical/Dental/Medication Cigarettes/Tobacco/Alcohol Cable TV Miscellaneous Total Flexible Expenses $ $ Life Insurance Total Expenditures Car Insurance Health/Accident Insurance Total Fixed: $ Car/Home Maintenance Total Flexible: $ Property Taxes Total Periodic: $ Total Periodic Expenses $ $ Total: $

7 Creditors Balance Owed Monthly Payment Last Payment Account Number 1st Mortgage 2nd Mortgage Other Mortgage Loan Total Mortgages $ $ Credit Card Debt Total Credit Card Debt $ $ Car/Personal Loans Total Car/ Personal Loans $ $ Medical Debt Total Medical Debt $ $ Other Debt Grand Total for All Debt $ $

8 Durham Regional Financial Center 2634 Durham-Chapel Hill Blvd ~ Suite 212 ~ Durham, NC Voice: Fax: Website: Durham Regional Financial Center Counseling Services Disclosure Form Durham Regional Financial Center may make you aware of products and/or services that we believe offer value to our clients. These products and/or services might be available directly from Durham Regional Financial Center, lenders, developers, or other agencies with which Durham Regional Financial Center has a working relationship. You are under no obligation to use the products and/or services identified by Durham Regional Financial Center, whether by us or from industry partners. Services provided by Durham Regional Financial Center: FE: Financial Education No Charge FC: Financial Counseling $35.00 CC: Credit Counseling $35.00 DMP: Debt Management Program $40.00 enrollment fee TBB: The Benefit Bank Services No Charge REN: Rental Counseling $35.00 HBE: Homebuyer Education No Charge PPHC: Pre-Purchase Homeownership Counseling $35.00 PPHC: Post Purchase Homeownership Counseling $35.00 PFHC: Pre-Foreclosure Homeownership Counseling No Charge FHA: FHA Back to Work Counseling $ HECM: Reverse Mortgage Counseling $ Client s Printed Name: Signature: Date: / / Client s Printed Name: : Signature: Date: / /

9 Client Bill of Rights We pledge that our clients have the right: To prompt counseling services for managing money and addressing mortgage issues, based on their financial situations: To treatment with dignity and respect To be actively involved in a comprehensive assessment of their financial situation including an appropriate action plan: To express dissatisfaction through a Complaint Resolution Process; To discontinue their relationship with our agency at any time: To ask questions and to have concerns addressed. We are committed to providing you with high quality, professional services. However, if you are not satisfied with the services provided or if you want to make a complaint, we ask that you follow these guidelines. Step One: Complaint Resolution Process Try to resolve the issue with the staff member involved, giving him specific information about your complaint. Step Two: If it not possible, or the issues is not resolved to your satisfaction, write or call Anthony Alizieri, Sr. Vice President and Chief Operating Officer 2634 Durham-Chapel Hill Blvd ~ Suite 212 ~ Durham, NC Step Three: Agency may request a meeting with you (phone or face-to-face) or seek more information from a staff person. The agency will respond within 15 days. Step Four: If your issue is still unresolved, you may appeal in writing directly to the head of the agency, Glyndola Massenburg-Beasley, President and Chief Executive Officer 2634 Durham-Chapel Hill Blvd ~Suite 212 ~ Durham, NC After additional fact finding, this individual will provide you a concluding decision to you within 15 days. Step Five: If your issue continues to be unresolved, you may make a final appeal in writing to Deryl Gantt, Durham Regional Financial Center Board of Directors P. O. Box 1269 ~ Durham, NC Our Agency serves all members of the community. We do not engage in the practices of discrimination in the selection and participation of clients in our programs or services with respect to race, religion, color, gender, sex, national origin or handicap.. Applicant Applicant Counselor Counselor

10 Required Documents for Rental Counseling and Transitional Housing Services Please provide copies only keep originals for your records. Section 1: What to Bring for Your Initial Session 1) Pay Stubs (for a 60 day pay period) or Unemployment Award Letter 2) W-2 or Tax Returns 3) Support Documents for: Child Support, Alimony, Social Security, Disability (if applicable) 4) Two Months of Bank Statements 5) Rent Receipts 6) Utility Bills Section 2: Customers must provide the documents under each category that applies. For questions, contact us at: or info@drfcenter.org If you are a salaried or hourly employee: Most recent and consecutive pay stubs showing 30 days of income and year-to-date earnings (less than 60 days old) If you are self-employed: 1) Most recent quarterly or year-to-date profit/loss statementsigned and dated, 2) Business federal tax return form the previous 5 years ( signed and dated) If you belong to a Homeowners Association: Most recent bill or letter from Homeowners/Condominium Association reflecting amount and frequency of dues If you receive alimony, child support or separation maintenance as qualifying income: Divorce decree, separation agreement, other written agreement filed with the court, or decree that states the amount and period of time payment will be received If you receive income from social security, disability or death benefits, pension, adoption assistance, public assistance, unemployment or if your employment is seasonal: Benefits statement or letter from the provider that states the amount, frequency and duration of the benefit If unemployed, proof of unemployment wages for a minimum of 3 months If you have income from any other source(s) such as tips, commission renter income or investments: Documentation describing the nature of the income, such as an employment contract, tenant rental agreement, spouse/ parental support, tips, etc. Section 3: All authorized signers listed on credit card accounts are required to complete the following disclosures: 1) Privacy Policy 2) Third Party Authorization