- FBH Community

Prosperity Needs Assessment

Assessment of clients current financial and familial situation. Allows the Homes Brings Hope team to see what is needed to support their journey to becoming financially stable or home buyer ready.

Today's Date

Will you be applying for the home loan by yourself or with others?

Yourself

You and another person

You and two people

Name(Required)

First Last

Name of second applicant

First Last

Name of third applicant

First Last

Gender

Male

Female

Other

Gender of second applicant

Male

Female

Other

Gender of third applicant

Male

Female

Other

Primary Race

American Indian, Alaska Native, or Indigenous

Black, African American, or African

Native Hawaiian or Pacific Islander

White

Other

Select one

Primary Race of second applicant

American Indian, Alaska Native, or Indigenous

Black, African American, or African

Native Hawaiian or Pacific Islander

White

Other

Select one

Primary Race of third applicant

American Indian, Alaska Native, or Indigenous

Black, African American, or African

Native Hawaiian or Pacific Islander

White

Other

Select one

Ethnicity

Non-Hispanic/Non-Latino(a)

Hispanic/Latino(a)

Select one

Ethnicity of second applicant

Non-Hispanic/Non-Latino(a)

Hispanic/Latino(a)

Select one

Ethnicity of Third Applicant

Non-Hispanic/Non-Latino(a)

Hispanic/Latino(a)

Select one

Please indicate your current housing status:

Permanent stable housing

Homeless

Staying in a motel/hotel

Staying in a shelter/transitional housing

Other

Residential Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long have you been at your current address?

Does the other applicant live in the same address?

Yes

Do the others applying live in the same address?

Yes

No, but they live together

No, and they live separately

Residential Address of Second Applicant

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Residential Address of Third Applicant

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Phone Number

Second Applicant Contact Phone Number

Third Applicant Contact Phone Number

Alternative/Emergency Contact

Email(Required)

Second Applicant Email

Third Applicant Email

Date of Birth

Date of Birth of Second Applicant

Date of Birth of Third Applicant

Are you or any members of your household a Veteran or Active-Duty Service Member?

Yes

How many adults (ages 18+, including yourself) live in the household?

Are there any children (ages 0-17) living in the household?

Yes, there are children living in the home

No, there are no children living in the home

What are the names, ages and genders of all children living in your household?

Please share the school(s) the child/children attend

Are you currently employed?

Yes

Benefit services you are currently receiving?

What is your average monthly income?(Required)

Name of Employer

Current title

Length of time in current position (Year(s), Month(s))

Please indicate your current FICO credit score(Required)

Your FICO score can be obtained through your bank, existing credit cards, or through annualcreditreport.com for FREE.

Is the second applicant currently employed?

Yes

Benefit services the second applicant is currently receiving?

What is the average monthly income of the second applicant?

Name of Employer for Second Applicant

Current title

Length of time in current position (Year(s), Month(s))

Please indicate the second applicant current FICO credit score

Your FICO score can be obtained through your bank, existing credit cards, or through annualcreditreport.com for FREE.

Is the third person currently employed?

Yes

Benefit services the third applicant is currently receiving?

What is the average monthly income of the third applicant?

Name of Employer for Third Applicant

Current title

Length of time in current position (Year(s), Month(s))

Please indicate the third applicant current FICO credit score

Your FICO score can be obtained through your bank, existing credit cards, or through annualcreditreport.com for FREE.

What is the highest level of education you have completed?

I Did Not Complete High School

High School Diploma/ General Education Diploma (GED)

Certificate/Vocational/Technical Program

Associate’s Degree (2 years of College)

Bachelor’s Degree (4 Years of College)

Master’s Degree

Doctoral/Professional Degree

Other

Do you have an existing financial obligation at a college or university (Student Loan debt)

Yes

Unsure

Have you filed for bankruptcy?

Yes

Are you comfortable using a computer?

Yes

I have some knowledge, but my skills are limited

Which areas of personal finance is a concern?

Saving Little to No Money

Not Having an Emergency Fund

Losing My Job or Not Being Able to Earn A Higher Salary

Not being able to pay my debt (credit cards/student loans/medical bills, etc.)

Not being able to cover the cost for maintenance and/or repairs to my vehicle

Not being able to afford healthcare needs

Paying my rent/mortgage on time

Other

Which of the following may be barriers to homeownership

Lack of Down Payment Assistance/Help with Closing Costs

Limited Housing Within My Price Range

Housing Discrimination

Unstable Employment

Low Credit Score

High Debit-to-Income Ratio (Existing Debt)

I Have Never Tried to Purchase a Home

Other

Please share why you are interested in homeownership?

Is there any additional information you would like to share with FBH Community staff?

Do you need help with getting information on community resources?

Yes

Which of the following services (if any) could we support you with?

Would you like more information on where to access free or reduced cost medical/dental care?

Yes, please connect me to these services

No, I do not need support accessing these services at this time

Do you currently have health insurance for yourself?

Yes, I have health insurance

No, I do not have health insurance

I do not wish to respond

Do you have a health insurance plan for your dependents?

Yes, I currently have a health insurance coverage for my dependents

No, I do not have health insurance coverage for my dependents

I do not wish to respond

Do you have a dental insurance plan?

Yes, I have dental insurance

No, I do not have dental insurance

I do not wish to respond

Do you or members of your household have concerns with managing stress, anxiety, addiction, and/or other mental health areas of need?

Yes

I do not wish to disclose this information