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Homebuyer Education Intake Form

  • This downloadable form can be printed and filled out in advance of your appointment. Please bring your completed intake form to your intake appointment.

Electronic Fillable Form

Rocky Mountain Development Council, Inc., Counseling Agreement and Disclosure

By checking yes I am agreeing to the above agreement and disclosure form.

Privacy Policy and Practices of Rocky Mountain Development Council, Inc.

By checking the opt-in box you are agreeing to allow Rocky to disclose information as stated in the above privacy policy.
By checking the opt-out box I am directing Rocky not to make the disclosures found in the above privacy policy.

Applicant/Co-Applicant Release and Authorization

By checking the boxes you are agreeing to the terms found in the applicant/co-applicant release and authorization form

Right to Financial Privacy Act of 1978

Additional Information

Did you receive child support?
Did you receive child support?
Secondary Applicant
Secondary Applicant
Did anyone in your household receive SSI?
Did anyone in your household receive SSI?
Secondary Applicant
Are you a Veteran?
Are you a Veteran?
Secondary Applicant
Are you active military?
Are you Active Military
Secondary Applicant
Do you know your Credit Score?
Do you know your Credit Score?
Secondary Applicant
Secondary Applicant
Have you filed Chapter 13 bankruptcy?
Have you filed for Chapter 13 bankruptcy?
Secondary Applicant
Secondary Applicant
Have you filed for Chapter 7 Bankruptcy?
Have you ever filed for Chapter 7 bankruptcy?
Secondary Applicant
Secondary Applicant
Have you had a home foreclosure?
Have you had a home foreclosure?
Secondary Application
Secondary Applicant
Do you have active collections?
Do you have active collections?
Secondary Applicant
Secondary Applicant

Liabilities/Debts

Please list a description, current balance, and monthly payment associated with current liabilities/debt
Please list a description, current balance, and monthly payment associated with current debt/liabilities.
Secondary Applicant

Personal Profile of Primary Applicant

First Name *
Middle *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
DATE OF BIRTTH
Month
/
Day
/
Year
Gender
Handicapped
Current Housing Arrangement
Household Type
Please select the most accurate
Rural Status
Please select the most accurate
English Proficiency
Education
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Month
/
Day
/
Year
Employment Status
Race
Ethnicity
Foreign Born
Who referred you to us:

Personal Profile - Secondary Applicant

First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Month
/
Day
/
Year
Gender
Handicapped
Current Housing Arrangement
Household Type
Rural Status
English Proficiency
Education
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Month
/
Day
/
Year
Employee Status
Race
Ethnicity
Foreign Born
Who referred you to us?
  • Rocky's Agency on Aging
    Rocky's Agency on Aging
  • WEATHERIZATION
    WEATHERIZATION
  • LIHEAP
    LIHEAP
  • MOW 2022
    MOW 2022
  • Head Start Logo
    Head Start Logo
  • Rocky Mountain Preschool logo
  • AmeriCorps Seniors
    AmeriCorps Seniors
  • Community Action Partnership logo
    Community Action Partnership logo

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