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HRC Application

Intake Form MUST be completed in one sitting and you MUST have an Email Address (Create a Gmail account). Please be prepared to spend at least 10-15 minutes completing the entire application. Make sure that you complete the intake application process by uploading your documents and scheduling your appointment (HRC does not accept walk-in appointments).

After submitting your form you will receive a confirmation email.

In order to complete the intake form you will need**:
1. Photo ID for the primary household member
2. Social security cards or birth certificates for ALL household members (or proof of citizenship or legal residency)
3. Proof of all sources of income for the most recent month (60 days for Emergency Assistance and 30 days for all other types) for all household members 18 years or older
4. Your lease agreement (ALL pages and signed), notice of delinquent balance/ 12-month rental payment ledger, and eviction/ court notice (if available)
5. Copies of any delinquent utility bills, including internet
6. Copies of award/ action letters for other assistance (SNAP, etc.)
7. Bank statements for the most recent 60 days (Not required for Emergency assistance only for ALL other types)
**Uploading documents in advance allows you to request an expedited appointment. A complete intake provides you the opportunity to access a greater variety of services. If you have difficulty providing these documents during the online process you can provide them during your appointment.

If you experience a problem, please Call 216-474-4472 or Email Us for assistance at helpwithhousing@famicos.org. Due to a high volume of requests and inquiries, direct telephone contact with HRC staff will be limited.

Please do not reapply by completing multiple Intake Forms! Multiple intake submissions will cause delays! Participation in our counseling program does not guarantee eligibility or approval for financial assistance.
Famicos Foundation Homeownership Resource Center

This Application MUST be completed in one sitting. Please be prepared to complete the entire application. On average, the application takes about 15 minutes to complete.

Contact Information

First Name*

Last Name*

Phone Number*
Please enter a valid phone number.

Phone Type*

Additional Phone Number (if any)
Please enter a valid phone number.

Additional Phone Type

Enter your Email*

Confirmation Email Please confirm your email. Be sure to enter an email that you can access, it is important to your application process.

Please Enter Your Address

House Number*

Street Name*

Apt. or Unit

City*

County*

State*

Zip Code*

Personal Information

Date of Birth*

MonthDay Year
Date

Gender*

MaleFemaleGender Non-conformingChose not to respond

Race*

Ethnicity*

Social Security Number*

Marital Status*

What is your primary language?*

Do you need interpretive services?*

YesNo

What is your highest education? *

Do you have a documented disability?*

YesNoUnknownChose not to respond

Military Status*

US VeteranActive DutyNon-militaryPrefer not to respond

What service(s) would you like to receive at the Health, Housing & Hiring Resource Fair on December 3, 2022?*

Emergency Help (ie. Rental & Utility Assistance)Expungement ConsultVaccines (COVID & Flu)Manage Your MoneyBuy a Home

How did you hear about us?

Famicos Foundation WebsiteFrom a friendSocial MediaRadioOther

Household Information

Do you rent or own your residence?*

RentOwnOther

Head of Household Type*

How many people live in your household?*

How many people in your household are above the age of 18? *

Monthly rent amount (excluding utilities)*

What is your monthly mortgage payment?*

Mortgage Loan Type*

Housing Assistance

Are you able to pay your mortgage next month?*

YesNo

Are you able to pay your rent next month?*

YesNo

Have you been notified of a Court Date for Eviction?*

YesNo

Have you been notified of a Court Date for Foreclosure?*

YesNo

Total amount of rent owed*

Total number of months' rent due*

Are you late on your mortgage payments?*

Primary reason for housing instability*

Secondary reason for housing instability (if any)

Have you received rental assistance from Famcios Foundation or other organizations in the past 24 months?*

YesNoUnsure

Income Sources and Public Benefits

Employment Status*

Employer

Job Title

Sources of income that you (applicant) are CURRENTLY receiving. (please check ALL that apply).*

Full-time EmploymentPart-time EmploymentSelf-EmploymentSpousal SupportChild SupportInvestment IncomeSocial SecuritySocial Security Disability InsuranceIncome from AssetsPension/AnnuityUnemploymentAdoption SubsidyShort term DisabilityLong term DisabilityVeteran's BenefitsFamily ContributionFood StampsOther

Primary Full-time Employment Income Amount
per year

Primary Self-Employment Income Amount
per year

Primary Child Support Income Amount
per year

Primary Social Security Income Amount
per year

Primary Social Security Disability Insurance Income Amount
per year

Primary Pension/Annuity Income Amount
per year

Primary Adoption Subsidy Income Amount
per year

Primary Long Term Disability Income Amount
per year

Primary Family Contribution Amount
per year

Primary Part-time Employment Income Amount
per year

Primary Spousal Support Income Amount
per year

Primary Investment Income Amount
per year

Primary Food Stamps Income Amount
per year

Primary Veteran's Benefits Income Amount
per year

Primary Short term Disability Income Amount
per year

Primary Unemployment Income Amount
per year

Primary Income from Assets
per year

Primary Other Income Amount
per year

Secondary Income

Please enter a secondary income if applicable. These spaces can be left blank if you do not receive any other income.

Secondary Income Earner's Name

Sources of income that secondary household member is CURRENTLY receiving. (please check ALL that apply).

Full-time EmploymentPart-time EmploymentSelf-EmploymentSpousal SupportChild SupportInvestment IncomeSocial SecuritySocial Security Disability InsuranceIncome from AssetsPension/AnnuityUnemploymentAdoption SubsidyShort term DisabilityLong term DisabilityVeteran's BenefitsFamily ContributionFood StampsOther

Full-time Employment Income Amount
per year

Self-Employment Income Amount
per year

Child Support Income Amount
per year

Social Security Income Amount
per year

Social Security Disability Insurance Income Amount
per year

Pension/Annuity Income Amount
per year

Adoption Subsidy Income Amount
per year

Long Term Disability Income Amount
per year

Family Contribution Amount
per year

Part-time Employment Income Amount
per year

2 Spousal Support Income Amount
per year

Investment Income Amount
per year

Food Stamps Income Amount
per year

Veteran's Benefits Income Amount
per year

Short term Disability Income Amount
per year

Unemployment Income Amount
per year

Income from Assets
per year

Other Income Amount
per year

Any Other Income

These spaces can be left blank if you do not receive any other income.

Please describe any other income source:

Other income dollar amount:

COVID-19

Is your Hardship COVID-19 Related (happened since March 1st 2020)? I/we certify that I/we have been adversely impacted by the Coronavirus and I/we are seeking this assistance to address or mitigate an unmet need.*

YesNo

Did you benefit from the eviction or foreclosure ban during COVID-19 pandemic?*
The eviction ban stopped landlords from removing tenants for not paying rent during the pandemic.

Did you enter into a forbearance agreement during COVID-19 pandemic?*
Mortgage forbearance is an agreement between you and your lender to provide you with temporary relief from paying your mortgage for a specified amount of time, either by lowering or pausing the payments.

Did you or a household member receive Pandemic Unemployment Assistance (PUA) or Federal Pandemic Unemployment Compensation (FPUC) funds?*

YesNoUnsure

Property Management Information

By providing your property owner's information, you authorize us to contact them to discuss your housing situation. Email is the preferred method of contact. To assist us with processing, please provide their Email address, if available.

Landlord / Property Manager*

Landlord / Property Management Phone Number*
Please enter a valid phone number.

Landlord / Property Management Email
example@example.com

Acknowledgement & Submit

I/we certify that all provided information is correct to the best of my knowledge. I/we authorize Famicos Foundation/ Homeownership Resource Center to verify all information contained on this online form and to pull my credit report. I/we understand that I may be assisted by federal funds which carry severe penalties for providing false information, including incarceration.

Famicos Foundation/ Homeownership Resource Center will obtain updates to my credit report throughout my participation in the program at key points in time for housing counseling in connection with my pursuit of a loan to purchase real property, receive housing stability counseling services, receive rental assistance, receive foreclosure prevention services, review my credit file for financial debt obligations and for informational inquiry purposes. I further authorize Famicos Foundation to obtain a copy of the Closing Disclosure, Appraisal, and Real Estate Note(s) upon the purchase of a home, from the lending institution providing the loan and/or the title company that closed the loan.

I/we understand that these credit pulls will not have any adverse effect on my credit history, rating or score.

I/we acknowledge that I have received a copy of the following: (1)The Homeownership Resource Center Disclosures; (2)E-SIGN/Consent To Electronic Delivery Of Correspondence; (3)The Privacy Policy; (4)Home Inspection Disclosure (as applicable); and (5)List of Community Resources.

I/ we acknowledge that I received a copy of the intake & disclosure documents in my primary language, upon request for translation and/or interpretation services, if other than English.

I/We understand that any intentional or negligent representation(s) of the information contained on this form may result in civil liability and/or criminal liability under the provisions of Title 18, United States Code, Section 1001.

We offer homeownership services to residents in Cuyahoga County, Ohio. You indicated that your home is outside of our service area. If you need assistance finding your local resources, check out the links below:

HUD Approved Housing Counseling Agencies

Fair Housing Center

Ohio Legal Help

Ohio Housing Finance Agency

Applications for CARES Act Funding:

Signature

Sign Here*

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Print Name*

Date*

MonthDay Year
Date of signature

Should be Empty:
- Services

HRC Application

Famicos Foundation Homeownership Resource Center

Contact Information

Please Enter Your Address

Personal Information

Household Information

Housing Assistance

Income Sources and Public Benefits

Secondary Income

Any Other Income

COVID-19

Property Management Information

Acknowledgement & Submit