Dear Homeowner,
PRIMARY RESIDENCE .
Please bring the following with you to your appointment:
Mortgage Statement
Any notices from the court or attorneys regarding foreclosure
Proof of income (paystubs, award letter, etc.)
Please be prepared to discuss the hardship which caused you to fall behind, your sources of income, and your household expenses.
If you are going to be late, please call in advance to let us know. If you have any other questions, please call the office during normal business hours. with Our office is open from 9:00 am – 6:00 pm Monday – Thursday 9:00 am to 1:00 pm Friday.
Please note: If you need assistance due to language barriers, mobility impairments, visual or hearing impairments, or any other disabilities, please let us know so that we can provide necessary accommodations.
Sincerely,
Kingdom CDC Staff
HCO #
Referral Source
Appointment Date
HOMEOWNER INTAKE SHEET
Applicant Name
Applicant Birthdate
Applicant SS
Address
City
State
Postal Code
How long have you lived in current address?
Contact Number
Email Address
Highest Level of education completed
Total # of Dependents
Age of Dependents
Employer
Amount Paid
How often
Weekly
Bi-weekly
Monthly
Bi-Monthly
Other
Occupation
How long on current job
Other Sources of Income:
Amount of Income
Present Housing Situation:
Mortgage Co
Loan No.
Monthly payment
How many months delinquent?
2nd Mortgage
Loan No.
Monthly payment
How many months delinquent?
Monthly Amount
Hearing/Sell Date
Hardship Summary
Note: If any problem after signing occurs, please click the blue button with red X to clear it and sign again.
Co-Applicant
Co-Applicant - Name
Birthdate
SSN
Phone Number
Email Address
Highest Level of education completed
Previous Address if less than 2 yrs
Total # of Dependents
Age of Dependents
Employer
Amount Paid
How often
Occupation
How long at current employment
Other Sources of Income
Amount of Income
CLIENT BUDGET ANALYSIS
Client Budget Analysis For
Mortgage
2nd Mortgage
Groceries
Utilities
Gas/Heat
Electricity
Water/Sewer
Trash Pickup
Alarm Service
Communication
Telephone
Cellphone
Internet
Automobile
Car Payment
Car Insurance
Fuel/Parking
Maintenance
Car Payment
Car Insurance
Fuel/Parking
Maintenance
Taxes
Real Property
Personal Property
Insurance
Health/Dental
Life
Homeowners
Rental Insurance
Debt
Total Credit Card Payments
Total Loan Payments
Medical Expenses
Prescriptions
Co-Pay
Medical Bill Payments
Miscellaneous
Clothing
Tobacco
Work Lunch
Eating Out
Professional Dues
Grooming
Contributions
Allowances
Cleaning Supplies
Hobbies
Lessons
Recreation
Cable TV
Pet Care
Child Care
Other
Amount
Counseling Services and Disclosure Statement
I/We understand that it is my/our right and responsibility to decide whether to engage in any
course of housing counseling with kingdom Community Development Corporation and to
determine if counseling is suitable for my housing concerns.
Rental Housing Counseling Services and Partnership Disclosure Form
Counseling agencies are committed to serving clients that are rent burdened or may be facing
eviction. Rental Housing Counseling 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
Housing Counselors or other agencies with which Counselors has a working relationship. You are
under no obligation to us, the products and/or services identified by Housing Counseling,
whether by us or from industry partners.
DPC: Mortgage Delinquency and Default Resolution CounselingPPF: Pre-Purchase CounselingRHC: Rental Housing CounselingFHW: Fair Housing Pre-Purchase Education WorkshopPPW: Pre-Purchase Homebuyer Education Workshops RHW: Rental Housing Workshops
Applicant’s Printed Name
Co-Applicant’s Printed Name
Privacy Notice
Kingdom Community Development is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We assure you that all information shared, both orally and in writing, will be managed within legal and ethical considerations. Your personal financial information, such as your total debt
information, income, living expenses, and personal information concerning your financial circumstances, will be provided to creditors and possibly others with your specific authorization.
We may also use aggregated case file information for the purpose of evaluating services, gathering valuable research information, and designing future programs. Your anonymity will be maintained through the use of
your client number or by using aggregated data in all circumstances.
In all other situations, your information may be released to appropriate individuals or agencies ONLY UPON WRITTEN REQUEST or when our staff has been serviced by a valid subpoena.
The following PRIVACY PRACTICES detail the circumstances under which we will release your information to a third party:
We do not disclose any nonpublic personal information about the client or former clients to
anyone, except permitted by law.
We may compile data and aggregate information that you give us, but this information may not be
disclosed in a manner that would personally identify you in any way.
We may disclose some or all of the information that we collect, as described below, to creditors, or third parties that you have authorized who need this information in order for us to assist you after a counseling session.
We may disclose all of the information thatwecollect as described below creditors and related financial institutions who need this information in order to put you on a debtsolver
program (DSP).
We restrict access to nonpublic 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 to guard your nonpublic personal information.
We collect nonpublic personal information about you from the following source:
We may disclose the following kinds of nonpublic information about you:
RELEASE: I hereby authorize Kingdom Community Development Corporation to release all nonpublic information it obtains about me, to (1) my creditors and (2) any third parties necessary to resolve the matter(s) discussed during my counseling session.
I further RELEASE and authorize all of my creditors to provide nonpublic information about me to this Housing.
Counseling Agency
Authorization to Release Information
I/We,
authorize the release of any personal and financial information requested by Kingdom Community Development Corporation employees Amy Kemp, Tiffany Johnson, Remona Gregory or other delegated staffer including:
Employment and Income Records
Checking, Savings, and/or Other Deposit Account Records Social Services, VA, and Other
Benefit Payment Verifications
Courthouse and Other Public Records (titles, liens, taxes, fixed assets verifications, etc.)
Creditor and/or Collection Account Information
Mortgage Account Information AND/OR documents, Foreclosure Information, and/or
Rental history
This authorization should be extended to any employee of Kingdom CDC identifying themselves with the company information listed below AND with the required personal information to identify me.
Upon receipt, you are authorized to speak with KingdomCDC employees by phone
and to provide information both verbally and in writing as requested. This authorization should be considered ongoing and enforced indefinitely from the date of signature.
Social Security Number
Social Security Number
Property Address
Primary Contact Phone Numbers
Loan Number
AUTHORIZATION TO CREDIT REPORT REQUEST
Counselors Initials
Last Name
First Name
Middle Name
SSN
Address
DOB
Spouse Name
Spouse SSN
Spouse DOB
SAMPLE HARDSHIP LETTER
DATE:
Letter of Hardship
Loan Number
Applicant
Co-Applicant
Required Documents Checklist
Upload your most recent month’s paystubs for all borrowers, proof of additional income,
your two(2) most recent bank statements and your 2022 tax return including your W-2’s
and tax schedule:
Proof of Income
Mortgage Statement
Bank Statement
Tax Returns
Utility Bills
Submit
