Utah Homeowners Assistance Fund Application

Please select your language.

Prepare

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

Economic Profile: Household income, Assets, and Debts
Documents: Paystubs, Bank Statements, W-2 of all household members that earn income

Save

Click the "Save my progress and resume later" link at the top of any page. You'll be prompted to submit an an email and password. Afterwards you'll receive an email with a link that can be used later to open the application and continue working. When you return to complete the form, you will need to provide the same email and password.

Tip: If your internet connection is inconsistent, save your progress as you go.

Submit

All required fields must be filled. Any left blank will be highlighted in red when you attempt to submit. Once your application is submitted, your service coordinator will respond within 3-5 business days to discuss your eligibility and next steps.

Applications will not be reviewed unless the Client Profile is complete and all requested documents are provided.

1. Client Information

Have you received services from other counseling agencies? If so, list the agency name

Agency Name

How did you hear about our organization?

Primary Applicant

First Name

Middle Initial

Last Name

Email Address

Autoresponder Email

Is there an agency helping you fill out and complete the application?

Agency Representative Information

Agency Name

Agency Representative Name

Agency Representative Phone number

Agency Representative Email Address

Contact Information

Preferred Phone

Home Phone

Mobile Phone

Mailing Address

Home Mailing Address

City

State

Zip Code

Primary Applicant Profile

Date of Birth

Please use the format mm/dd/yyyy e.g. 12/30/2020

Primary Language

Other Primary Language

Marital Status

Gender

Do you identify as one of the following? Please review and select if any of the below options that apply.

SSN

Do not use the dash symbols. Just enter numbers.

Race

Ethnicity

Highest Level of Education

Employment Status

Co-Applicant

Is there a Co-Applicant?

YesNo

Contact Information

First Name

Middle Initial:

Last Name

Preferred Phone

Mobile Phone

Home Phone

Date of Birth

Please use the format mm/dd/yyyy e.g. 12/30/2020

Email

SSN

Do not use the dash symbols. Just enter numbers.

Co-Applicant Profile

Gender

Race

Ethnicity

Employment Status

Relation to Applicant

Highest Level of Education

2. Household Information

Household Information

Household Type

Other Household Type

Is there a household member who is:

Hold CTRL or Command to select multiple values

Household English Proficiency

ProficientNot Proficient

Do you need special accommodations for language or disability?

Does your household have additional household members? It is IMPORTANT that you ADD any additional family member or person that is living in your household. NOT adding everyone can make you ineligible for this program.

YesNo

Additional Household Member

Full Name

First Name

Last Name

Date of Birth

Please use the format mm/dd/yyyy e.g. 12/30/2020

Household member aged 18 or older

Gender

Race

Ethnicity

Educational Attainment

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

YesNo

Does this person live in the house more than 183+ days in a calendar year?

YesNo

Application role

Include in Service File

3. Economic Profile

Applicant Employment / Income Source Information

Supply each income source the Applicant receives. Sources of income include earned income from employment as well as benefits, social security and child support.

Applicant Primary Income Source

Employer Name/Source of Income

Business Type

Title

Start Date

Please use the format mm/dd/yyyy e.g. 12/30/2020

Income Type

Pay Period

Hourly Income

Average Hours Worked per Week

Gross Monthly Income

Net Monthly Income

Gross Annual Income

Co-Applicant Employment / Income Source Information

Supply each income source the Co-Applicant receives. Sources of income include earned income from employment as well as benefits, social security and child support.

Does the Co-Applicant have an income source?

YesNo

Co-Applicant Primary Income Source

Employer Name/Source of Income

Business Type

Title

Start Date

Please use the format mm/dd/yyyy e.g. 12/30/2020

Income Type

Pay Period

Hourly Income

Average Hours Worked per Week

Gross Monthly Income

Net Monthly Income

Gross Annual Income (Co applicant)

Is/Are the household members employed?

Yes

No

Please add all household member employment information

Additional Household Member Employment / Income Information

First Name

Last Name

Email Address

Employer Name/Source of Income

Title

Start Date

Please use the format mm/dd/yyyy e.g. 12/30/2020

Pay Period

Hourly Income

Average Hours Worked per Week

Gross Monthly Income

Net Monthly Income

Business Type:

Income Type:

Gross Annual Income (HH Member)

Financial History

Have you ever been involved in the foreclosure process?

YesNo

What was the date of your first notice of foreclosure?

Please use the format mm/dd/yyyy e.g. 12/30/2020

Have you declared bankruptcy in the past 7 years?

YesNo

What was the date of your bankruptcy discharge?

Please use the format mm/dd/yyyy e.g. 12/30/2020

I certify that the information above is true and correct to my knowledge:

Applicant Name (Applicant
Name acts as a signature)

Co-Applicant Name (Co-Applicant Name acts as a signature)

Applicant Signed Date

Co-Applicant Signed Date

Client Documents

Please attach the following documents as part of your application, to add more documents click on add another response link..

(File Types Accepted: .bmp .gif .jpg. jpeg. png. tif .qtf .doc .docx .xls .xlsx .pdf )

* All attached files may not exceed 35 MB

Government issued Identification- Acceptable forms of ID include: (Driver’s License, State Issued ID, Passport, Military ID, Permanent Resident Card

Most recent Mortgage Statement:

Most recent HOA Statement (If applicable)

Demand Letter, Notice of Default, Notice of Sale or Foreclosure Notice from Lender/Servicer (if applicable)

How many files would you like to upload? (max. of 3)

Household Income Documentation- Most Recent 60 days of income including most recent 60 days of paystubs, W-2, 1099, Unemployment Award Letter, Social Security Award letter, Disability (Temporary or Long-Term SSDI) Award Letter, Workers Compensation Documentation, Federal Tax Returns (if self-employed, provide a copy of Schedule C)

How many files would you like to upload? (max. of 13)

Bank Statement (Most recent 30 days)

How many files would you like to upload? (max. of 3)

Demand Letter, Notice of Default, Notice of Sale or Foreclosure Notice from Lender/Servicer (if applicable)

Household Income Documentation- Most Recent 60 days of income including most recent 60 days of paystubs, W-2, 1099, Unemployment Award Letter, Social Security Award letter, Disability (Temporary or Long-Term SSDI) Award Letter, Workers Compensation Documentation, Federal Tax Returns (if self-employed, provide a copy of Schedule C)

Bank Statement (Most recent 30 days)

If additional documents are needed to be uploaded please click the following link

Here!