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Applicant and Co-Applicant Details

In this section, please enter your most up to date contact information and demographic information.

The Applicant (and Co-Applicant, if applicable) should be an adult member of your household that will be able to represent, provide information for, and make decisions on behalf of your household. 

Please prepare for upload: Photo Identification and Social Security Cards for each Applicant and Co-Applicant.

Household Members

Please enter additional members who reside in your household (i.e. children, dependents, other family members, etc.). Use the "Add Additional Household Member" link to add as many as you need.

You do not need to re-enter Applicant or Co-applicant (if applicable) information here.

Please prepare for upload: For each household member, be prepared to provide verification that they are your dependents - such as Social Security Cards and Birth certificates

Current Income Sources and Public Benefits

Please enter all sources of Income and Public Benefits that the household is CURRENTLY receiving, for all household members over the age of 18. 

Use the "Add Additional Income Source" link to add as many as you need

Current Annual Income is the estimated income for the current year including any wages,

benefits, alimony, child support and other forms of financial income or support.

Income includes: Full-time employment, part-time employment, self-employment, spousal support, child support, investment income, Social security, SSI, SSDI, income from assets, pension/annuity, unemployment, adoption subsidy, short term disability, long term disability, veteran's benefits, zero income, family contribution, other

Public benefits include: Food stamps, WIC, ADC, OWF/TANF, rental subsidy, utility allowance, other public benefit

Please prepare for upload: Verification of income for the past 30 days - pay stubs, employment letters, award letters, etc. 

Assets Declaration
Please enter all liquid Assets you have control over for all household members over the age of 18. Liquid assets are cash on hand or assets in any other form that can be converted to cash within 20 days (SSA.gov)

Asset types include: Bank Accounts - Savings and/or Checking, Investment Accounts, Retirement, Certificates of Deposit, Cash on Hand, Pre-paid Debit Cards, Health Savings Accounts, Life Insurance Cash Value

Upload Documents

Please use this page to upload documents that support your application. You can attach electronically downloaded documents, use a scanner, or take pictures or screenshots of your documents with your phone.

You can upload multiple files per section by using the "Add another ..." link. There is a limitation of 20 files per form. If you have more than 20 files to upload, please email them to info@neorenthelp.org.

Gather the required documents:
1. Photo identification for all household members 18 years or older
2. Verification of household members (Social Security card preferred, or birth certificate) for all household members
3. Lease (which can be obtained from landlord if not available to tenant) 

Complete applications with all required supporting documents will be processed faster - please upload as much as you are able to and ensure you have documents for each section!  

WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

Housing Counseling Disclosure

About Us and Program Purpose: The mission of CHN Housing Partners (CHN) is to build strong families and vibrant neighborhoods through quality affordable housing and strengthened financial stability. CHN is a nonprofit, HUD-approved housing counseling agency. We provide free housing counseling and education services, including Mortgage Delinquency & Default Resolution, Reverse Mortgage, Pre-purchase, Financial, Budgeting, & Credit Repair, and Rental Housing Counseling services, as well as Financial, Budgeting, & Credit Repair and Pre-purchase Homebuyer Education Workshops. We serve all clients regardless of income, race, color, religion/creed, sex, national origin, age, family status, disability, or sexual orientation/gender identity. We administer our programs in conformity with local, state, and federal anti-discrimination laws, including the federal Fair Housing Act (42 USC 3600, et seq.). As a housing counseling program participant, please affirm your roles and responsibilities along with the following disclosures and initial, sign, and date this form below.

Client and Counselor Roles and Responsibilities

Termination of Services: Failure to work cooperatively with your housing counselor and/or CHN will result in the discontinuation of counseling services. This includes, but is not limited to, missing three consecutive appointments. By signing below, you are acknowledging that you have read and understood this. 

Agency Conduct: No CHN employee, volunteer, or agent shall undertake any action that might result in, or create the appearance of, administering counseling operations for personal or private gain, provide preferential treatment for any person or organization, or engage in conduct that will compromise our agency’s compliance with federal regulations and our commitment to serving the best interests of our clients.

Agency Relationship: CHN has financial affiliation with HUD, United Way of Greater Cleveland, the State of Ohio, Cuyahoga County, the City of Cleveland, and banks including Third Federal, KeyBank, and JP Morgan Chase. As a housing counseling program participant, you are not obligated to use the products and services of CHN or our industry partners.  

Alternative Services, Programs, and Products & Client Freedom of Choice: In the interest of full disclosure, CHN also provides utility services with partnerships through: Dominion East Ohio, Illuminating Company, Cleveland Public Power, Division of Water, NEO Regional Sewer District, and U.S. Department of Energy, Health, and Human Services. CHN also provides tax preparation through a partnership with Enterprise Community Partners and the IRS VITA program. As a housing counseling client, you are not obligated to participate in any of these services. You are entitled to choose whatever services and/or products best meet your needs. 

Fees: CHN currently charges a fee of $125 for Reverse Mortgage Counseling, paid to CHN upon service. All other direct services are free of charge. Service cannot be denied due to an inability to pay and cannot impose a financial hardship. CHN also offers two online homebuyer education platforms, Framework and eHome America, which cost $75 and $99, respectively, and are paid directly to the vendor. If applicable, I/we acknowledge that you received a copy of CHN’s Fee Structure at the time Reverse Mortgage Services were provided. 

Referrals and Community Resources: CHN provides a community resource list which outlines regional services available to meet a variety of needs, including utility assistance, food banks, and legal aid assistance, among others. This list also identifies alternative agencies that provide services, programs, or products identical to those offered by CHN. 

Privacy Policy: I/we acknowledge that you received a copy of CHN’s Privacy Policy.

Home Inspection: If applicable, I/we acknowledge that you received a copy of ‘For Your Protection: Get a Home Inspection’ and ’10 Important Questions to Ask Your Home Inspector’.

Errors and Omissions and Disclaimer of Liability: I/we agree that CHN, its employees, agents, and directors are not liable for any claims and causes of actions arising from errors or omissions by such parties, or related to my participation in CHN counseling; and I hereby release and waive all claims of action against CHN and its affiliates. I have read this document, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law. If any provision of this document is unenforceable, it shall be modified to the extent necessary to make the provision valid and binding, and the remainder of this document shall remain enforceable to the full extent allowed by law. Please note that representatives of CHN do not provide tax or legal advice and that you should consult your tax advisor or attorney for such guidance.

Quality Assurance: In order to assess client satisfaction and in compliance with grant funding requirements, CHN, or one of its partners, may contact you during or after the completion of your housing counseling service. You may be requested to complete a survey asking you to evaluate your client experience. Your survey data may be confidentially shared with CHN grantors such as HUD.

Sharing of Information: By signing this Disclosure Statement I give CHN authorization to share my information with HUD and other third parties, as applicable.

Clients of Neighborhood Housing Services of Greater Cleveland, Inc.: In July of 2019, NHS of Greater Cleveland, Inc. became an affiliate of CHN and all housing counseling activities of both agencies are now administered and managed by CHN. If you were an active client of NHS of Greater Cleveland, Inc. before July 2019 we require your agreement to allow CHN employees to access your information across our integrated platform in the ways and for the purposes outlined above. You may receive this request from us even if you have a current authorization form on file with NHS of Greater Cleveland, Inc. 

HSCP: CHN receives funding through the Housing Stability Counseling Program (HSCP). I understand that HSCP may review my file for monitoring and compliance purposes. HSCP may conduct follow-up with as it relates to program evaluation. 

Privacy Policy:

CHN Housing Partners CHN) is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all personal information shared orally and/or in writing will be managed within ethical and legal consideration. Additionally, we want you to understand how we use the personal information we collect. Please carefully review this notice as it describes our policy regarding the collection and disclosure of your nonpublic, personal information.

 What is nonpublic, personal information?

• Information that identifies an individual personally and is not otherwise publicly available information, such as your Social Security Number or demographic data such as your race and ethnicity
• Includes personal financial information such as credit history, income, employment history, financial assets, bank account information and financial debts

Acknowledgement & Submit

I/we certify that all provided information is correct to the best of my knowledge and have received a copy of CHN's Housing Counseling Disclosure and Privacy Policy. I/we authorize CHN Housing Partners 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, including incarceration.

CHN's Housing Counseling Disclosure and Privacy Policy

By typing my full name below, I hereby authorize CHN to release nonpublic personal information it obtains about me to any third parties necessary to provide me with the services I requested. I acknowledge that I have read and understand the above privacy practices. I understand I will receive a copy of all information submitted at the email address I provided on Page 2, "Applicant E-mail Address".

Tenants - Everyone Deserves a Safe and Healthy Home! Click on the link to read further.