Enrollment Application & Budget Form: Foreclosure Prevention Survey

1.Instructions

PLEASE READ CAREFULLY BEFORE STARTING SURVEY.

Thank you for providing Prosperity Unlimited the opportunity to partner with you in reaching your goal for foreclosure prevention, home retention, and/or increasing your long-term financial sustainability.

Step One: Complete this Enrollment Application Package.

Questions 1-63 - Application
- (If you do not have a Co-Applicant, select No or N/A in the appropriate spots)
Questions 64-122 - Budget Form (only fill out what applies)

Step Two: Provide the Required Documents. They are needed to complete your assessment.

Visit www.prosperitycdc.org/2024/mdi.php for the document list.

Please read carefully the instructions on the delivery of the required documents to Prosperity.

Documents can be delivered via:

Fax: 704-938-7431
Email: helpdesk@prosperitycdc.org (must be in “PDF” format) Do not send pictures, zipped files or use Google Docs or Dropbox
Mailing Address: Prosperity Unlimited, Inc.; P. O. Box 1095; Concord, NC 28026
Hand delivered by appointment only – Please call 704-933-7405

1660 Garnet Street, Kannapolis, NC 28083

Do not mail your information to the physical address – UPS or FedEX only.

Step Three: Once you have provided the required documents, the Counselor will assess your case and may pull a tri-merge “soft hit” credit report if necessary for the evaluation. Through this your file will be assessed for the following:

Foreclosure Prevention (if available):
Stage of delinquency;
Housing affordability;
Types of loan retention options (if applicable);

Other Services:
Credit Enhancement Education;
Money Management and Budgeting

Step Four: Attend the appointment that will be scheduled for you to meet with a Counselor via Zoom or Phone Session for a detailed counseling session and a review of your assessment.

NOTE: A session will not be scheduled until you provide all the required documentation.

Should you have any questions, about the process you may email sconley@prosperitycdc.org or helpdesk@prosperitycdc.org.

1.Applicant (Borrower)(Required.)

First & Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Co-Applicant (co-borrower), Partner or other adult whom will be living in the house

First & Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

3.Will the person in Question 2 be included on the determination?(Required.)

Yes - (include all documentation on the Required Documentation Checklist)

No - (include all documentation on the Required Documentation Checklist)

Not Applicable

4.Do you have a pending Foreclosure Hearing date?(Required.)

Yes

If Yes, please enter the date and provide copy of the documentation.

5.Do you have a pending Foreclosure Sale date?(Required.)

Yes

If Yes, please enter the date and provide copy of the documentation.

6.What NC county do you live in?(Required.)

7.Country of Birth(Required.)

Applicant/Borrower

Co-applicant/Co-borrower

8.Rural Area Status(Required.)

Household lives in a rural area

Household does not live in a rural area

9.Residency Status(Required.)

Own

Rent

Other (please specify)

10.What is your monthly house payment?(Required.)

11.Are you current on your monthly house payment?(Required.)

Yes

If no, how many months behind and what is the dollar amount?

12.How long have you lived at current address?(Required.)

13.Race - Borrower/Applicant:(Required.)

Other (please specify)

14.Race - Co-Applicant/Co-Borrower/Partner:

Other (please specify)

15.Ethnicity - Borrower/Applicant:(Required.)

16.Date of Birth - Borrower/Applicant:(Required.)

Enter below:

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

17.Date of Birth - Co-Borrower/Co - Applicant:

Enter below:

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

20.Citizenship:(Required.)

Non-Resident Alien - Please provide documentation

US Citizen - Please provide Social Security Card & Driver's License

Permanent Resident - Please provide documentation

DACA - - Please provide Social Security Card & Driver's License

Applicant

Non-Resident Alien - Please provide documentation

US Citizen - Please provide Social Security Card & Driver's License

Permanent Resident - Please provide documentation

DACA - - Please provide Social Security Card & Driver's License

Co-Applicant

Non-Resident Alien - Please provide documentation

US Citizen - Please provide Social Security Card & Driver's License

Permanent Resident - Please provide documentation

DACA - - Please provide Social Security Card & Driver's License

Other (please specify)

21.List Dependent(s) - Birth dates (MM/DD/YYYY) and Age
Example: Jane Doe - 01/01/2015 - 5 add N/A if not applicable(Required.)

22.Preferred Language:(Required.)

Applicant/Borrower

Co-applicant/Co-Borrower

English

Applicant/Borrower

Co-applicant/Co-Borrower

Spanish

Applicant/Borrower

Co-applicant/Co-Borrower

Other

Applicant/Borrower

Co-applicant/Co-Borrower

Other (please specify)

23.What is the highest level of education you have completed?

Choose Highest Level of Education

Applicant/Borrower

Co-applicant/Co-Borrower

26.Are you currently in a IRS or State tax repayment plan?(Required.)

28.Do you pay child support?(Required.)

29.Do you make Alimony Payments?(Required.)

30.What is Borrower/Applicant employment history?(Required.)

Employer/Income Source:

Position/Title:

Start Date:

End Date:

Hourly Rate:

# of hours per week:

31.What is Borrower/Applicant employment history if less than two years in Question 32 or second job?

Employer/Income Source:

Position/Title:

Start Date:

End Date:

Hourly Rate:

# of hours per week:

32.How often are you paid?(Required.)

Weekly

Bi-weekly (every other week)

Semi-Monthly ( twice a month)

Monthly

33.Does Borrower/Applicant work for a school system?

Yes

Not Applicable

34.If the answer to Question 35 is yes, Is Borrower/Applicant a 10 or 12 month employee?

10 month employee

12 month employee

None of the above

35.What is Co-Borrower/Co-Applicant employment history?

Employer/Income Source:

Position/Title:

Start Date:

End Date:

Hourly Rate:

# of hours per week:

36.What is Co-Borrower/Co-Applicant employment history if Question 37 is less than two years or second job?

Employer/Income Source:

Position/Title:

Start Date:

End Date:

Hourly Rate:

# of hours per week:

38.Does Co-Borrower/Co-Applicant work for a school system?

Yes

Not Applicable

39.Is the answer to question 40 is yes, is co-borrower/co-applicant a 10 or 12 month employee?

Yes, 10 month employee

Yes, 12 month employee

None of the above

40.PLEASE READ CAREFULLY - APPLICANT CERTIFICATION: All of the information that I/We provided in this application for assistance is correct, complete and factual. No information has been withheld. We understand the necessity for accurate and complete information and we will provide any needed information to complete this application. We understand that deliberately providing inaccurate information or an unwillingness to timely provide the counselor with the necessary information or documents to assist us will result in a closing of our file.(Required.)

Yes

No. I realize that some services may not be available.

Applicant/Borrower

Yes

No. I realize that some services may not be available.

Co-applicant/Co-borrower

Yes

No. I realize that some services may not be available.

Current Progress,

0 of 122 answered