Enrollment Application & Budget Form: Foreclosure Prevention

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.

Question Title

* 1. Applicant (Borrower)

First & Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 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

Question Title

* 3. Will the person in Question 2 be included on the determination?

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

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

Not Applicable

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* 4. Do you have a pending Foreclosure Hearing date?

Yes

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

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* 5. Do you have a pending Foreclosure Sale date?

Yes

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

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* 6. What NC county do you live in?

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* 7. Country of Birth

Applicant/Borrower

Co-applicant/Co-borrower

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* 8. Rural Area Status

Household lives in a rural area

Household does not live in a rural area

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* 9. Residency Status

Own

Rent

Other (please specify)

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* 10. What is your monthly house payment?

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* 11. Are you current on your monthly house payment?

Yes

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

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* 12. How long have you lived at current address?

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* 13. Race - Borrower/Applicant:

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Choose not to respond

Other (please specify)

Question Title

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

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Choose not to respond

Other (please specify)

Question Title

* 15. Ethnicity - Borrower/Applicant:

	Hispanic/Latino	Not Hispanic/Latino	Choose not to response	N/A
Applicant/Borrower	Applicant/Borrower Hispanic/Latino	Applicant/Borrower Not Hispanic/Latino	Applicant/Borrower Choose not to response	Applicant/Borrower N/A
Co-applicant/Borrower	Co-applicant/Borrower Hispanic/Latino	Co-applicant/Borrower Not Hispanic/Latino	Co-applicant/Borrower Choose not to response	Co-applicant/Borrower N/A

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* 16. Date of Birth - Borrower/Applicant:

Enter below:

Date

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

Enter below:

Date

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* 18. What is your gender?

	Female	Male	N/A
Borrower/Applicant	Borrower/Applicant Female	Borrower/Applicant Male	Borrower/Applicant N/A
Co-borrower/Co-Applicant	Co-borrower/Co-Applicant Female	Co-borrower/Co-Applicant Male	Co-borrower/Co-Applicant N/A

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* 19. Marital Status:

	Married	Separated	Divorced	Never been married	Domestic Partners	Not Applicable
Applicant	Applicant Married	Applicant Separated	Applicant Divorced	Applicant Never been married	Applicant Domestic Partners	Applicant Not Applicable
Co-applicant	Co-applicant Married	Co-applicant Separated	Co-applicant Divorced	Co-applicant Never been married	Co-applicant Domestic Partners	Co-applicant Not Applicable

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* 20. Citizenship:

	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	Applicant Non-Resident Alien - Please provide documentation	Applicant US Citizen - Please provide Social Security Card & Driver's License	Applicant Permanent Resident - Please provide documentation	Applicant DACA - - Please provide Social Security Card & Driver's License
Co-Applicant	Co-Applicant Non-Resident Alien - Please provide documentation	Co-Applicant US Citizen - Please provide Social Security Card & Driver's License	Co-Applicant Permanent Resident - Please provide documentation	Co-Applicant DACA - - Please provide Social Security Card & Driver's License

Other (please specify)

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

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* 22. Preferred Language:

	Applicant/Borrower	Co-applicant/Co-Borrower
English	English Applicant/Borrower	English Co-applicant/Co-Borrower
Spanish	Spanish Applicant/Borrower	Spanish Co-applicant/Co-Borrower
Other	Other Applicant/Borrower	Other Co-applicant/Co-Borrower

Other (please specify)

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

	Choose Highest Level of Education
Applicant/Borrower	Applicant/Borrower Choose Highest Level of Education menu
Co-applicant/Co-Borrower	Co-applicant/Co-Borrower Choose Highest Level of Education menu

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* 24. Disabled:

	Yes	No	N/A
Borrower/Applicant	Borrower/Applicant Yes	Borrower/Applicant No	Borrower/Applicant N/A
Co-Borrower/Co-Applicant	Co-Borrower/Co-Applicant Yes	Co-Borrower/Co-Applicant No	Co-Borrower/Co-Applicant N/A

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* 25. Veteran/Military:

	Yes	No	N/A
Borrower/Applicant	Borrower/Applicant Yes	Borrower/Applicant No	Borrower/Applicant N/A
Co-Borrower/Co-Applicant	Co-Borrower/Co-Applicant Yes	Co-Borrower/Co-Applicant No	Co-Borrower/Co-Applicant N/A

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* 26. Are you currently in a IRS or State tax repayment plan?

	Yes	No	N/A
Borrower/Applicant	Borrower/Applicant Yes	Borrower/Applicant No	Borrower/Applicant N/A
If the answer is yes, what is the monthly amount?
Co-Borrower/Co-Applicant	Co-Borrower/Co-Applicant Yes	Co-Borrower/Co-Applicant No	Co-Borrower/Co-Applicant N/A
If the answer is yes, what is the monthly amount?

Question Title

* 27. Income Sources? (Select All That Apply)

	Employment	Retirement (Non Social Security)	Social Security/Disability	Child Support	Alimony	Other	N/A
Applicant	Applicant Employment	Applicant Retirement (Non Social Security)	Applicant Social Security/Disability	Applicant Child Support	Applicant Alimony	Applicant Other	Applicant N/A
Co-applicant	Co-applicant Employment	Co-applicant Retirement (Non Social Security)	Co-applicant Social Security/Disability	Co-applicant Child Support	Co-applicant Alimony	Co-applicant Other	Co-applicant N/A

Other (please specify)

Question Title

* 28. Do you pay child support?

	Yes	No	N/A
Borrower/Applicant	Borrower/Applicant Yes	Borrower/Applicant No	Borrower/Applicant N/A
If the answer is yes, what is the monthly amount?
Co-Borrower/Co-Applicant	Co-Borrower/Co-Applicant Yes	Co-Borrower/Co-Applicant No	Co-Borrower/Co-Applicant N/A
If the answer is yes, what is the monthly amount?

Question Title

* 29. Do you make Alimony Payments?

	Yes	No	N/A
Applicant/Borrower	Applicant/Borrower Yes	Applicant/Borrower No	Applicant/Borrower N/A
If the answer is yes, what is the monthly amount?
Co-applicant/Co-borrower	Co-applicant/Co-borrower Yes	Co-applicant/Co-borrower No	Co-applicant/Co-borrower N/A
If the answer is yes, what is the monthly amount?

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* 30. What is Borrower/Applicant employment history?

Employer/Income Source:

Position/Title:

Start Date:

End Date:

Hourly Rate:

# of hours per week:

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* 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:

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* 32. How often are you paid?

Weekly

Bi-weekly (every other week)

Semi-Monthly ( twice a month)

Monthly

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

Yes

Not Applicable

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* 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

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

Employer/Income Source:

Position/Title:

Start Date:

End Date:

Hourly Rate:

# of hours per week:

Question Title

* 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:

Question Title

* 37. How often is Co-Borrower/ Co- Applicant paid?

Weekly

Bi-weekly (every other week)

Semi-monthly (twice a month)

Monthly

Not Applicable

Question Title

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

Yes

Not Applicable

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* 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

Question Title

* 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.

	Yes	No	No. I realize that some services may not be available.
Applicant/Borrower	Applicant/Borrower Yes	Applicant/Borrower No	Applicant/Borrower No. I realize that some services may not be available.
Co-applicant/Co-borrower	Co-applicant/Co-borrower Yes	Co-applicant/Co-borrower No	Co-applicant/Co-borrower No. I realize that some services may not be available.

Enrollment Application & Budget Form: Foreclosure Prevention

1. Instructions

Question Title

* 1. Applicant (Borrower)

Question Title

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

Question Title

* 3. Will the person in Question 2 be included on the determination?

Question Title

* 4. Do you have a pending Foreclosure Hearing date?

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* 5. Do you have a pending Foreclosure Sale date?

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* 6. What NC county do you live in?

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* 7. Country of Birth

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* 8. Rural Area Status

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* 9. Residency Status

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* 10. What is your monthly house payment?

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* 11. Are you current on your monthly house payment?

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* 12. How long have you lived at current address?

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* 13. Race - Borrower/Applicant:

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

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* 15. Ethnicity - Borrower/Applicant:

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* 16. Date of Birth - Borrower/Applicant:

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

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* 18. What is your gender?

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* 19. Marital Status:

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* 20. Citizenship:

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

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* 22. Preferred Language:

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

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* 24. Disabled:

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* 25. Veteran/Military:

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* 26. Are you currently in a IRS or State tax repayment plan?

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* 27. Income Sources? (Select All That Apply)

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* 28. Do you pay child support?

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* 29. Do you make Alimony Payments?

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* 30. What is Borrower/Applicant employment history?

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

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* 32. How often are you paid?

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

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

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

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

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* 37. How often is Co-Borrower/ Co- Applicant paid?

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

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

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