Northwest Application - Homeownership Center Dayton

Do you have an accepted offer to purchase real estate?*

Yes
No

Please stop filling out the application and call 937-739-3540 for more information!

Applicant’s Last Name*

Applicant’s First Name/Middle Initial*

Is English your preferred language?*

Yes
No

Please call The HomeOwnership Center if you would like assistance in completing the application. Translation services are available. 937-853-1600

Current Address*

Street Address City State ZIP Code

Phone*

Email*

Applicant’s Social Security Number*

How did you learn about the Northwest Down Payment Assistance Program?*

Gender*

Female
Male
Other

Applicant’s Date of Birth*

Does someone in the household have a disability?*

Applicant
Co-Applicant
Dependent
No one in household has a disability

Applicant Education Level*

0-8
9-12 (non-grad)
HS Grad/GED
Post-Secondary (non-grad)
Associate/Bachelor's Degree
Graduate Degree

Marital Status*

Married
Not Married

Applicant Military Status*

Veteran
Active Military
N/A

Is Applicant a U.S. Citizen?*

Yes
No

Is there a co-applicant?*

Yes
No

Co-Applicant’s Last Name*

Co-Applicant’s First Name/Middle Initial*

Co-Applicant’s Relationship to Applicant?*

Co Applicant Current Address*

Street Address City State ZIP Code

Co-Applicant Phone*

Co-Applicant Email*

Co-Applicant’s Social Security Number*

Co-Applicant Gender*

Female
Male
Other

Co-Applicant’s Date of Birth*

Co-Applicant Education*

0-8
9-12 (non-grad)
HS Grad/GED
Post-Secondary (non-grad)
Associate/Bachelor's Degree
Graduate Degree

Co-Applicant Military Status*

Veteran
Active Military
N/A

Is Co-Applicant a U.S. Citizen?*

Yes
No

How many people are in your household?*

List all household members not already listed as Applicant and Co-Applicant.

Last Name	First Name, Middle Initial	Relationship to Applicant	Date of Birth	Race	Ethnicity

Information on Property Under Contract to Purchase

Property Address*

Street Address City ZIP Code

Will this home be used as your primary residence?*

Yes
No

Lender Information

Lending Institution*

Loan Officer Name*

Phone Number for Loan Officer*

Email for Loan Officer*

Real Estate Agent Information

Realty Company

Agent's Name*

Agent's Phone Number*

Agent's Email*

Household Income Information

Please list all current employment for the applicant and co-applicant*

Employer	Start Date	Whose Job	# of Hrs/Week	Gross Annual Income

Does ANYONE in your household receive non employment income (ex. Child Support, Social Security, Unemployment, Worker's Compensation, Veteran's Benefits, Pension, Other)?

Income Type	Who Receives?	Amount	Weekly, Monthly, Annually?

Information for Government Monitoring Purposes

The following information is requested by the federal government in order to monitor compliance with federal statutes that prohibit discrimination in housing. You are not required to furnish this information but are encouraged to do so. The law provides that a lender or servicer may not discriminate either on the basiss of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race you may check more than one sesignation. If you do not furnish ethniciy, race or sex, the lender or servicer is required to note the information on the basis of visual observation or surname if you have made this request in person. If you do not wish to furnish the information, select choose not to answer in drop down options.

Applicant's Race

Applicant's Ethnicity

Co-Applicant's Race

Co-Applicant's Ethnicity

Certifications and Signature(s)

I understand that Northwest Down Payment Assistance funds can only apply to properties within the Northwest Neighborhoods of the City of Dayton.*

Yes
No

I have not owned a home in the last 3 years.*

Yes
No

All of the information supplied in this application is true and complete to the best of my (our) knowledge.*

Yes
No

I give my (our) permission to the HomeOwnership Center to conduct further credit and financial investigation to determine eligibility for funding.*

Yes
No

I understand that provide false or incomplete information shall be considered cause to be disqualified from the Northwest Down Payment Assistance Program.*

Yes
No

I (we) understand that I (we) are applying for financial assistance which will be secured by a mortgage (for 5 years) on the property described herein.*

Yes
No

I(we) understand and certify that the property will not be used for any illegal or restricted purpose.*

Yes
No

I (we) hereby submit this application for the Northwest Down Payment Assistance from the HomeOwnership Center of Greater Dayton*

Yes
No

Applicant Signature*

Co-Applicant Signature*

Upon submission, a HOC staff member will contact you with a list of documents needed to process application. All documents MUST be submitted before The HomeOwnership Center can evaluate eligibility. If able, please submit the following items now:

Photo identification of the applicant(s) (i.e. driver’s license)
Executed Contract to Purchase Reasl Estate

Please call us if you have questions about the program or required documents: 937-853-1600.

Upload the required documents now.

Drop files here or

Max. file size: 2 MB.

This program is made possible by funding from Aloft Dayton: Advancing Racial Equity.

Northwest DPA

Information on Property Under Contract to Purchase

Lender Information

Real Estate Agent Information

Household Income Information

Information for Government Monitoring Purposes

Certifications and Signature(s)

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The HomeOwnership Center is an Equal Opportunity Lender

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