MANNA Homeownership Center Online Intake Form

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Welcome to the MANNA Online Housing Counseling Intake Form. Please complete and electronically sign this online form to apply for housing counseling services offered by MANNA, Inc.

Household Information: Birth dates, Employment and Education / School info

Economic Profile: Household income, Assets, and Debts
Current Living Situation: Rent and Utility costs

All required fields must be filled. Any left blank will be highlighted in red when you attempt to submit. Once your application is submitted, you will receive a response from MANNA within 4 business days to discuss your next steps.

Fair Housing Act (42 USC 3600, et seq.)

If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)

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1. Applicant Information

Provide details for the Primary Applicant below. The Primary Applicant will be the main contact for MANNA. It is not required that the Primary Applicant be the most significant contributor to the family income. If there is a Co-Applicant, another household member that will be a co-borrower or co-owner, please include their details also.

Primary Applicant

First Name

Last Name

Date of Birth

Social Security Number

Preferred Language

Contact Information

Email Address

Mobile Phone

Please use this format: 555-555-5555

Preferred Phone

Home Phone

Please use this format: 555-555-5555

Mailing Address

Home Mailing Address

Apt. or Unit No.

City

State

Zip Code

DC Ward No.

MD County

VA County

Date moved to this address

Applicant ID

Is there a Co-Applicant?

YesNo

Co-Applicant

Co-Applicant First Name

Co-Applicant Last Name

Co-Applicant Date of Birth

Co-Applicant Social Security Number

Please use this format: 555-55-5555

Co-Applicant Contact Information

Co-Applicant Email

Co-Applicant Phone

Please use this format: 555-555-5555

Co-Applicant ID

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2. Household Information

Please provide information on any other members of your household, such as children, grandparents, or other adults in the household who are full time or part time residents. This information helps calculate your household size. Demographic information is not a criteria in the approval process but provides a clearer picture on the types of families who might benefit from affordable housing opportunities.

Does your household have additional household members?

YesNo

Additional Household Member

First Name

Last Name

Full Name

Date of Birth

Is this Household member a dependent of the Applicant and/or Co-applicant?

YesNo

Does this person live in the house more than 50% of the time?

YesNo

Optional Demographic Information

Gender

Race

Ethnicity

Educational Attainment

Employment Status

Fair Housing Act (42 USC 3600, et seq.)

If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)

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Current Living Situation

Outline information about your current housing and expenses on this page.

What best describes your current living situation?

How many bedrooms are in your current home?

Current Housing Payment (rent or mortgage)

Are you a first-time Homebuyer?

YesNo

Are you a first generation Homebuyer?

YesNo

Please describe any special needs or accommodations required by your household. For example, "one-level only" or "at least one ADA-accessible bathroom required."

What services do you need from MANNA? If you are applying for HPAP or EAHP, please type in HPAP and/or EAHP in the box below. Other services could be homebuyer counseling, credit counseling, etc.

Demographic Information

Demographic information is not a criteria in the approval process but provides a clearer picture on the types of families who might benefit from affordable housing opportunities. If you do not feel comfortable responding, you can elect the option "Prefer not to respond"

Applicant Demographics

Applicant Gender

Applicant Race

Applicant Ethnicity

Applicant Educational Attainment

Applicant Military Status

Co-Applicant Demographics

Co-Applicant Gender

Co-Applicant Race

Co-Applicant Ethnicity

Co-Applicant Educational Attainment

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Document Upload

Driver's License or Government ID with Picture (required to process your application)

Please update your Government Picture ID (required)

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APPLICANT DISCLOSURES

Fair Housing Act (42 USC 3600, et seq.)

If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about our services, please talk to us about arranging alternative accommodations. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.)

I UNDERSTAND MANNA INC. IS A NON-PROFIT ORGANIZATION THE US DEPARTMENT OF HOUSING (HUD) AND THE GOVERNMENT OF THE DISTRICT OF COLUMBIA WHICH PROVIDE FUNDING FOR THIS PROGRAM REQUIRE PROOF OF HOMEOWNERSHIP. WHEN I PURCHASE I WILL PROVIDE MANNA INC. A COPY OF MY HUD-1/CLOSING DISCLOSURE (CD). WHEN I TURN IN MY HUD-1/CLOSING DISCLOSURE (CD) I WILL RECEIVE MY HOUSE WARMING $50.00 GIFT CARD AT THAT TIME.

I authorize MANNA, Inc. and its subsidiaries (MANNA's Homeownership Center) to perform the verification of the information provided on this form as to my credit and employment. By request I can receive a copy of this application. I acknowledge the above information is to be used in assessing my readiness for homeownership. I certify the above information is correct to the best of my knowledge. I understand the processing fee is to cover the cost of my credit report and administrative process fee. I understand and agree that my photo/image can be used in MANNA publications and/or own MANNA, Inc social media pages/website.

Disclosure Form for Housing Counseling Clients

I agree to participate in MANNA, Inc.'s Homeownership Center (HOC) programs to help me become a prospective homeowner. The Homeownership Center offers one-on-one counseling, homebuyer education, and peer support group meetings through Homebuyers Club (HBC). These services are designed to help me develop the skills needed budgeting, savings and debt management to prepare for loan pre-approval.

I understand that I am under no obligation to purchase a home from Manna, Inc.

I understand that the Homeownership Center (HOC) provides information and education on numerous loan products and housing programs, and I further understand that the housing counseling I receive from HOC in no way obligates me to choose any of these loan products or housing programs.

I authorize my counselor to discuss any information about my credit history, financial situation, employment and/or any other information related to my personal circumstances that may be necessary, with me, and with other agencies or representatives of financial institutions as necessary to assist me in improving my housing situation. I understand that information about my personal circumstances will be treated as totally confidential and no information about me will be discussed with anyone not directly involved in our efforts to prepare me for homeownership.

I understand that I may be referred to other housing services of the organization or another agency or agencies as appropriate that may be able to assist with concerns that have been identified. I understand that I am not obligated to use any of the services offered to me whether by Manna, Inc., the Homeownership Center (HOC), or by another agency or agencies.

It is further understood that in consideration of Manna, Inc. and the HOC assistance with my housing situation, I agree to hold harmless Manna, Inc., the Homeownership Center (HOC), and its agents and/or employees from all claims or cause of actions arising, or which may arise from mistakes, errors or omissions in regards to these efforts.

I acknowledge that I have read this Privacy Policy and Authorization in entirety, understand my rights to privacy, and approve of the authorizations mentioned.

I UNDERSTAND THIS APPLICATION IS NOT A MORTGAGE LOAN APPLICATION AND MANNA INC. IS NOT A LENDER.

Acknowledgement

Applicant Full Name

Today's Date

Co-Applicant Full Name

Today's Date