Housing Counseling and Financial Coaching Intake

I would like to work with a Housing Counselor or Financial Coach regarding the following area. Please note that sessions will focus on only one area at a time. Please choose the area you'd like to focus on first.(Required)
Me gustaría trabajar con un asesor de vivienda o asesor financiero con respecto a la siguiente área. Tenga en cuenta que las sesiones se centrarán en un solo área a la vez. Elija primero el área en la que desea centrarse.
Please tell us why you would like to work 1-1 with a counselor or coach and what steps you have taken to prepare yourself already. (Díganos por qué le gustaría trabajar 1-1 con un consejero o entrenador y qué pasos ha tomado para prepararse.)
Indicate your preferred language below if you are unable to communicate in English (Indique su idioma preferido a continuación si no puede comunicarse en inglés).
Español
Other (please indicate)
 
Name (Nombre y apellido)(Required)
Address (Domicilio)(Required)
Please enter a number from 1 to 2.
Living at your address. (Vivir en tu dirección.)
Children/people in your care. (Niños/personas bajo su cuidado.)
Living Arrangement (Arreglo de vivienda)(Required)
Do any of the below apply to you? (Algo de lo siguiente se aplica a usted)(Required)
DD/MM/YYYY
Gender (Género):(Required)
Marital Status (Estado civil)?(Required)
Education (Educacion)(Required)
Ethnicity (Ethnicidad)(Required)
Race (Raza)(Required)

Income (Ingresos)

Please answer the following questions using gross income (before taxes). Responda las siguientes preguntas utilizando el ingreso bruto (antes de impuestos).
Are you employed? (¿Está empleado?)(Required)
We will not contact your employer unless we have your permission. (No nos pondremos en contacto con su empresa a menos que tengamos su permiso.)
Including wages, public assistance, SSI, child support, etc. (Incluidos salarios, ayudas públicas, SSI, pensión alimenticia, etc.)
Include all adult household members. (Incluya a todos los miembros adultos del hogar.)
Dollars
Do you receive Social Security or Disability benefits? (¿Recibe prestaciones de la Seguridad Social o por incapacidad?)(Required)
Do you receive Child Support or Alimony? (¿Recibe pensión alimenticia?)(Required)
Do you receive a pension? (¿Recibe una pensión?)(Required)
Do you know your credit score? (¿Conoce su puntuación crediticia?)(Required)
Please enter a number from 350 to 850.
My Monthly Debts are (Mis deudas mensuales son):(Required)
Include minimum payments only (Incluir solo pagos mínimos).
Car Loan (Préstamo de automóvil)
Mortgage Loan (Hipoteca)
Credit Card(s) (Tarjeta(s) de crédito)
Student Loan (Préstamo estudiantil)
All Others (Otros)
 
Drop files here or
Accepted file types: pdf, png, jpg, gif, Max. file size: 512 MB, Max. files: 4.
    The last 30-consecutive days of your paystubs.
    You will need at least 1-hour available for your appointment. (Necesitará al menos 1 hora disponible para su cita.)
    I understand that a Housing Counselor or Financial Coach will work with me to address the areas that I've chosen free of charge. I commit to attending appointments scheduled and completing items that I agree to put on my action plan within the agreed upon timeline. If I fail to do these things, I understand that my Counselor or Coach has the right to discontinue services so that they can focus on other people who need help.(Required)
    Link for Privacy Policy and Program Disclosure are found here: https://lacasainc.net/fec-privacy-and-program-disclosure/ I/We hereby certify that the above information is true and complete to the best of my/our knowledge. Lacasa is a HUD approved agency and member of NeighborWorks America Network. It is extremely important for us to track the number of class participants that purchase a property. The information we collect allows us to report the impact that our services have in our community as well as to fulfill grant requirements. Data collected in this intake is for informational purposes ONLY. Lacasa does not send marketing or publicity material of any kind.(Required)
    (El enlace para la Política de Privacidad y Divulgación del Programa se encuentra aquí: https://lacasainc.net/fec-privacy-and-program-disclosure/ Por la presente certifico/certificamos que la información anterior es verdadera y completa a mi leal saber y entender . Lacasa es una agencia aprobada por HUD y miembro de NeighborWorks America Network. Es extremadamente importante para nosotros realizar un seguimiento del número de participantes en la clase que compran una propiedad. La información que recopilamos nos permite informar el impacto que nuestros servicios tienen en nuestra comunidad, así como cumplir con los requisitos de subvención. Los datos recopilados en esta ingesta son SÓLO para fines informativos. Lacasa no envía material de marketing o publicidad de ningún tipo.)
    This field is for validation purposes and should be left unchanged.