Sample – Home Buyer Education Intake Form

Home Buyer Education - Intake Form

  • Participant

    Please circle the most accurate
  • Other than those listed by any co-borrower
  • Separate ages with commas
    If Yes, list below
  • Gross Income
  • Co-Participant

  • Other than those listed by borrower
  • Separate ages with commas
  • Authorization, Verification & Disclosure

  • Some or all of the Agencies that fund the Homeownership Center at Willamette Neighborhood Housing Services (WNHS) require the information requested above. This information will only be used for reporting purposes to our funders.

    I acknowledge receipt of the WNHS Privacy Policy and understand the privacy options regarding this information.

    I understand that WNHS provides home buyer education and counseling services as well as mortgage financing. I further understand that the housing counseling services provided at WNHS, while designed to assist in becoming mortgage-ready, do not direct or restrict me to a particular lender or loan product, and that I am under no obligation to utilize the WNHS mortgage financing products. I understand that WNHS encourages me to choose mortgage financing that meets my needs and is in my best interest.

    I authorize WNHS to:

    1. Obtain a copy of the HUD-1 Settlement Statement, Appraisal, and Real Estate Note(s) when I purchase a home from the lender who made me a loan and/or title company that closed the loan.

    I hereby verify this information to be true and accurate to the best of my knowledge, and if asked can prove accuracy of the information. I understand the fee I am paying is non-refundable. I identify the person(s) signing the registration form to be the customer/s receiving services from WNHS.

    *I understand that in order to obtain some down payment assistance programs completion of this class must be within the past two years. If a certificate is needed after that date, I will need to re-enroll and complete the series again.

  • This field is for validation purposes and should be left unchanged.