Homeownership Resource Center 139 South Dean Street Spartanburg, South Carolina 29302 864-504-3090 Fax: 864-504-3097
UPSTATE HOUSING PARTNERSHIP (INTAKE)
Applicant Information
Please Print Clearly
Name: (First/Middle/Last)
Date of birth:
SSN:
Phone:
State:
ZIP Code:
Current address:
City:
(Please circle)
Own
Home Phone:
Rent
CELL:
EMAIL:
Preferred method of contact:
Male ____ Female ____
Family/Household Size: _______
Marital Status: Single__ Married__ Divorce __ Other __
Referred by:
Preferred Language:
Employment Information
language
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
Position:
Total Monthly Income
ZIP Code:
Annual Family/Household Income:
Race: American Indian/Alaska Native: __ Asian __ Black/African American __White __ Multiple Race ___________________
Ethnicity: Hispanic: Yes __ No __ (If yes please circle) Cuban
U.S Citizen Yes___ No ___
Mexican
Puerto Rican
Other Hispanic
Foreign born: Yes ____ No ____
Veteran: Yes __ No __ Active Military: Yes __ No __ Disabled: Yes __ No __ Female Head of Household: Yes __ No __
SERVICE TYPE:(select one)
Education ___ Home Purchase ___ Mortgage Default ___ Rental ____ Homeowner Services ___
Co-applicant Information
Name:
Date of birth:
SSN:
Phone:
State:
ZIP Code:
Current address:
City:
Relationship:
Circle one
Male
Female
Household Information/Demographics
Current Housing Arrangement (Please circle) 1. Rent 2. Homeless 3. Homeowner with mortgage 4. Living w/family member not paying
rent
Are you 1st time homebuyer(circle yes if you do not currently own a home & have not in past 3
Yes _____ No _______
years)
Education:
Below High School __
High School ___
College ___
Head of Household (single parent households only) _____
Disabled ______
Migrant Farm Worker ____
Using Section 8 Voucher Rent _____ Purchase _______
Section 8 voucher amount: ________
Additional Demographics
Household Type (please select the most accurate)
Married with children
Other
Female headed single parent household
_______
Married without children
Male headed single parent household
________
Two or more unrelated adults
Do you receive Public Housing
Assistance:
Yes. ____ No. ____
Homeownership Resource Center 139 South Dean Street Spartanburg, South Carolina 29302 864-504-3090 Fax: 864-504-3097
AUTHORIZATION
I authorize UHP Homeownership Resource Center to:
(a) pull my/our credit report to review my/our credit file for housing counseling in connection with my pursuit on a loan to purchase real
Property.
(b) pull my/our credit report to review my/our credit file for informational inquiry purposes; and
(c) obtain a copy of the HUD-1 Settlement, Appraisal, and Real Estate Note (s) when I purchase a home, from the lender who made me/us
a loan and/or the title company that closed the loan.
I/We understand that any intentional or negligent representation(s) of the information contained on this form may
result in civil liability and/or criminal liability under the provisions of Title 18, United States Code, Section 1001.
Signature of applicant
Date:
Signature of co-applicant:
Date: