Intake Application Form



Basic Informtion
Marital Status
Highest Education Level (Please check only one)
Are you a US Citizen?
Are you a permanent resident?
Are you a migrant farm worker?
Do you live within 50 miles from US/Mexico border?
Race/Ethnicity (check all that apply):


EMPLOYMENT FOR THE LAST TWO (2) YEARS


CO-APPLICANT INFORMATION
Marital Status
Highest Education Level (Please check only one)
Are you a US Citizen?
Are you a permanent resident?
Race/Ethnicity (check all that apply):


EMPLOYMENT FOR THE LAST TWO (2) YEARS


HOUSEHOLD INFORMATION
Household Type (Please check only one)


MONTHLY BUDGET


Expenses
Credit: Do any of the applicants have any credit problems we should know about?
Anything additional you would like for your counselor to know?


We can help you avoid foreclosure. Contact us today!

We specialize in providing in-person counseling in your community.

Contact Details

  • National Office Headquarters
    NID-Housing Counseling Agency
    7677 Oakport Street, Suite 1030
    Oakland, CA 94621
  • 1-877-670-7360
  • 1-888-334-8325
  • nidnational@nidonline.org