IDA Intake Form - Grassroots Community Development

Name (Primary Applicant) *

Primary Applicant Place of Employment *

Occupation or Job Title

Which shifts do you work?

Best time to call you?

Ethnicity

Hispanic Non-Hispanic Chose not to respond

Race

Marital Status

Married Single Unknown

Gender

Female Male Unknown

Education

Other

First Time Homebuyer Disabled Senior

Applicant Date of Birth

Ages of Family Members *

Annual Gross Income(before Taxes)*

2nd Persons Annual Gross Income *

What is your current housing Payment? *

How did you hear about our organization? *

By signing the consent below, you are allowing Grassroots CD to verify your credit report and to share this and all other information and documentation with others to obtain a mortgage, for the intended purpose of purchasing a home. You also allow Grassroots CD to share information with others about the performance of your case even after the file is closed. You are not required to purchase a home through a Grassroots CD program or use any service that Grassroots CD provides. Grassroots CD will provide you with a list of available service providers but does not endorse any service providers. You are free to choose any service provider. *

You will be required to sign this again at your first appointment.

I understand that my Grassroots Community Development housing counselor must pull a trimerge credit report for me and my co-borrower before my first appointment, and I agree to pay $48 Individual Report or $96 Joint report. *

You will be required to sign this again at your first appointment.

Committed to a brighter future for children, neighbors and communities.

Committed to a brighter future for children, neighbors and communities.

We consider a healthy neighborhood to be one that is safe, clean, and diverse; one in which it makes economic sense for people to invest and one where neighbors manage change successfully.

Individual Development Account online Intake form

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