Dear Prospective Homeowner,

Thank you for choosing NHS of Baltimore for your home purchase and financial needs!  


To schedule your financial coaching consultation, please upload your credit report receipt to your NHS account @ https://nhsbaltimore.force.com/nhsbaltimorecft.  No walk-ins until further notice.  Upon receipt and verification of your documents by our Intake staff, you will receive a web link via email to schedule your consultation.  


Sincerely,

NHS of Baltimore

REQUIRED DOCUMENTS

  1. NHS Financial Coaching Intake Packet (your completed form will be automatically uploaded to your NHS account.)
  2. Credit Report Receipt – Please visit RootedApp to pull your credit report.  The cost per credit report is $23.97.  Please upload your receipt to your NHS account.
  3. Credit Report

Demographic Information


















Gross is before taxes are taken out. Please include the monthly income for all household members.

Home Purchase Information






Please type your initials.

These forms are included in this intake application. Please type your initials.

If your contact preference is text, you must provide a valid number with the ability to accept text messages. By clicking submit, you consent to receive text messages from us. Messages and Data rates may apply. Message frequency will vary.










NHS of Baltimore Disclosure Statement
NHS of Baltimore is a Community Development Financial Institution with a mission to spark renewed vitality in neighborhoods by engaging community partners, increasing sustainable homeownership and advancing innovative capital solutions. To assist current and future residents of Maryland, we offer the following products and services. 

• Lending Products

• Home Buyer Education

• Pre-purchase Counseling

• Post-Purchase Education

• Financial Coaching


These products are available to any customer that requests them; however, NHS of Baltimore, Inc. does not mandate that any customer utilize any service other than those specified during intake. Customers are not obligated to receive any other services offered by the organization or its exclusive partners. 


Customer Statement

I have read the above-mentioned disclosure and understand that I am under no obligation and have not been steered toward any of the above products or services. 








This field will be completed by NHS staff.



Hold Harmless Agreement and Authorization

I (we) agree to hold harmless and indemnify NHS of Baltimore, Inc. and its employees, member officers and directors in connection with acts performed by them which would reasonably be associated with consultation, technical advice, financial counseling, loan processing, property inspection, construction management and other related activities. 


I (we) understand that NHS of Baltimore, Inc. provides financial capability counseling/coaching after which I will receive a written action plan consisting of recommendations for handling my finances, possibly including referrals and other agencies as appropriate.  


I (we) authorize the staff of NHS of Baltimore, Inc., to obtain specific reports and verifications such as personal credit reports, income and asset information, etc. from any organization or entity that may be involved during my customer journey with NHS.  


I (we) understand that NHS of Baltimore, Inc. submits customer-level information relating to the Financial Capability grant to the NeighborWorks America Data Collection System (DCS), opens files to be reviewed for program monitoring and compliance purposes, and conducts follow-up with customers related to program evaluation.  I (we) give permission for Financial Capability program administrators and/or their agents to follow-up with me within the next three years for the purposes of program evaluation.  


I (we) I understand that I may opt-out of this requirement, but proof of this opt-out must be recorded in my customer file. 


I (we) further agree to indemnify and hold harmless the City of Baltimore and its Department of Housing and Community Development; and the State of Maryland and its Department of Housing and Community Development, from any and all losses, claims or damages of every nature or description arising out of or in connection with this contract. 


I (we) understand that a photocopy of this form will serve as authorization. 










Credit Report Authorization
I (We) hereby give permission to pull my (our) credit report for the purposes of my (our) application for assistance in regard to my (our) home or my (our) mortgage loan.


Both Signatures are required if joint report is requested: 















BALTIMORE CITY COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

FAMILY/HOUSEHOLD INCOME VERIFIABLE CERTIFICATION


Information on your annual family or household income is required to determine your eligibility to benefit from some Community Development Block Grant (CDBG) Program assisted activities.   Each applicant is required to provide information regarding the number of persons in their family or household including the respective total annual gross income.  Information provided is subject to verification by representatives of the City of Baltimore and the U.S. Department of Housing and Urban Development (HUD). 

NOTE: "Income" is the total annual income of all family or household members as of the date of application.  Income of all persons in the family or household must be included in calculating family or household income whether or not all family or household members receive assistance.  Estimate the annual income by projecting the prevailing rate of income of each person at the time assistance is provided to the family or household. Report all income sources that you would include on a federal income tax return. 

INSTRUCTIONS: 
1) The number of persons in your family or household includes you, other adults, and    
        children.
2) Choose the income limit that is closest to your family or household gross income but is 
        NOT LESS THAN your family or household's gross income.  Note that household       
        income includes the monies earned and/or benefits received by all household 
        members.
3) Sign and date, under Applicant Statement, to certify your family or household size and 
        income.
CDBG CHART










APPLICANT STATEMENT: 
By signing this form, I certify that the information given on this form is true and accurate to the best of my knowledge.  I am aware that there are penalties for willfully and knowingly giving false information as an applicant for federally funded assistance or services, which may include immediate repayment of funds received and /or prosecution under applicable law.  I understand that the information on this form is subject to verification by representatives of Baltimore City, HUD or other Federal agencies under the Federal False Claims Act, 31 U.S.C. §3729 et. seq.  Upon request, I agree to provide supporting documentation of my family or household gross income including sources.









Lead Warning Statement
Housing built before 1978 may contain lead-based paint.  Lead from paint, paint chips, and dust can pose health hazards if not managed properly.   Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory.  Lead poisoning also poses a particular risk to pregnant women.  Potential homeowners should be aware that homes built prior to 1978 might contain lead and take appropriate measures to educate themselves on the dangers of lead poisoning prior to completing a sale on a home.  The seller of any interest in residential real property is required to provide the buyer with any information on lead-based paint hazards from risk assessments or inspections in the seller’s possession and notify the buyer of any known lead-based paint hazards from risk assessments or inspections in the seller's possession and notify the buyer of any known lead-based paint hazards.  A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase.

The "Protect your family from Lead in your Home" is being provided to prospective homebuyers to make certain they are aware of the dangers of lead in homes built prior to 1978.


Name of Housing Counseling Agency:  NHS of Baltimore

Name of Authorized Person:  Lissa C. Edgecomb

Signature of Authorized Person:  Lissa C. Edgecomb                

Date:

 

This is to certify that have received a copy of the Environmental Protection Agency's 

EPA Protect your family from lead in your home pamphlet.  







PRIVACY POLICY AND PRACTICES OF NEIGHBORHOOD HOUSING SERVICES OF BALTIMORE, INC (NHSB)

NHS of Baltimore is committed to the responsible management, use, and protection of your personal information. This notice describes our policy regarding the collection and disclosure of personal information.  Personal information, as used in this notice, means information that identifies an individual personally and is not otherwise publicly available information. It includes personal financial information such as credit history, income, employment history, financial assets and debt, your social security number, as well as other information that you have provided to us on any applications or forms that you have completed. 


INFORMATION WE COLLECT
We collect personal information to support our lending operations, financial counseling and to aid you in shopping for and obtaining a home mortgage.  We collect personal information about you from the following sources: 

Information that we receive from you on applications or other forms.
Information about your transactions with us, our affiliates or others.
Information we receive from a consumer reporting agency.
Information that we receive from personal and employment references.

INFORMATION WE DISCLOSE
We may disclose the following kinds of personal information about you:
Information we receive from you on applications or other forms, such as your name, 
        address, social security number employer, occupation, assets, debts and income.
Information about your transactions with us, our affiliates or others, such as your 
        account balance, payment history and parties to your transactions.
Information we receive from a consumer reporting agency, such as your credit bureau 
        reports, your credit history and your creditworthiness.

TO WHOM DO WE DISCLOSE 
We may disclose your personal information to the following types of unaffiliated third parties:
Financial service providers, such as companies engaged in providing home mortgage 
        or home equity loan.
Others, such as nonprofit organizations involved in community development, but only 
        for program review, auditing, research and oversight purposes.
In the case of partner referrals, we may disclose progress updates as needed.

YOU MAY OPT OUT OF CERTAIN DISCLOSURES
You have the opportunity to “opt-out” of disclosures of your nonpublic personal 
         information to third parties (such as your creditors), which means you direct us not to 
         make those disclosures.
You may opt-out of this requirement, but proof of your decision to opt-out must be 
         recorded in your customer file.

CONFIDENTIALITY AND SECURITY     
We restrict access to personal information about you to those of our employees who need to know that information to provide products and services to you and to help them do their jobs, including underwriting and servicing of loans, making loan decisions, aiding you in obtaining loans from others, and financial counseling.   We maintain physical and electronic security procedures to safeguard the confidentiality and integrity of personal information in our possession and to guard against unauthorized access. We use locked files, user authentication and detection software to protect your information.   Our safeguards comply with federal regulations to guard your personal information. 

IF YOU WANT MORE INFORMATION  
Please contact us at 410-327-1200 or write to us at 25 E. 20th Street, Suite 170, Baltimore Maryland 21218.  

By signing below, I hereby affirm that I have received the Privacy Policy for NHS.








GENERAL CONFLICT OF INTEREST POLICY


APPLICATION OF POLICY 
This policy applies to board members, employees, relatives of employees, and certain volunteers of NHS of Baltimore, Inc. (NHS), hereafter referred to as Staff.   A volunteer is covered under this policy if that person has been granted significant independent decision-making authority with respect to financial or other resources of the organization.   Customers of NHS are here in after referred to as “interested parties.”   

DETERMINING A CONFLICT OF INTEREST 
A conflict of interest may exist when the interests or concerns of Staff may be seen as competing with the interests or concerns of an Interested Party.  There are a variety of situations, which raise conflict of interest concerns including, but not limited to, the following: 

FINANCIAL INTERESTS 
A conflict may exist where Staff directly or indirectly benefits or profits as a result of a decision or transaction entered into with an Interested Party.  Examples include situations were: 
Staff contracts to purchase or lease goods, services, or property from an Interested  
        Party.
Staff purchases an ownership interest in or invest in property owned by an Interested 
        Party.
Staff is provided with a gift, gratuity or favor of a substantial nature from a person or 
        business entity for referring an Interested Party to that person or business entity.

OTHER INTERESTS  
A conflict may also exist where Staff obtains a non-financial benefit or advantage that they would not have obtained absent their relationship with an Interested Party.  Examples include: 
Staff seeks to make use of confidential information obtained from an Interested Party 
        for their own benefit or for the benefit of a relative, business associate, or other 
        organization.
Staff seeks to take advantage of an opportunity which they have reason to believe   
        would be of interest to an Interested Party.

DISCLOSURE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST       
Staff is under a continuing obligation to disclose any actual or potential conflict of interest as soon as it is known or reasonably should be known.   Staff shall complete a disclosure statement at such time as an actual or potential conflict arises and shall be provided to the Chief Executive Officer of the organization.  For board members, the disclosure statement shall be provided to the President (Chairman) of the Board. The President’s (Chairman’s) disclosure statement shall be provided to the Secretary of the Board.  

In the case of volunteers with significant decision-making authority, the disclosure statements shall be provided to the Chief Executive Officer of the organization. The Chief Executive Officer’s disclosure statement shall be provided to the President (Chairman) of the board. The Secretary of the Board shall file copies of all disclosure statements with the official corporate records of the organization.  Further, interested parties who believe that a conflict of interest may or does exist as a result of Staff's interaction with said interested party, may file a formal written complaint with the Chief Executive Officer of NHS. Whenever there is reason to believe that an actual or potential conflict of interest exists between Staff of NHS and an interested party, the board of directors shall determine the appropriate organizational response. This shall include, but not necessarily be limited to, invoking the procedures described below, with respect to a specific proposed action or transaction. 

PROCEDURES FOR ADDRESSING CONFLICTS OF INTEREST – SPECIFIC TRANSACTIONS 
Where an actual or potential conflict exists between Staff of NHS and an interested party with respect to a specific proposed action or transaction, Staff shall refrain from the proposed action or transaction until such times as the proposed action or transaction has been approved by the disinterested members of the board of directors of the organization.  The following procedures shall apply: 

Staff who has an actual or potential conflict of interest with respect to a proposed action or transaction of the corporation shall not participate in or be present during the deliberations and decision making of the organization with respect to such action or transaction.  Staff member, upon request, will be available to answer questions or provide material factual information about the proposed action or transaction. 

The disinterested members of the board of directors may approve the proposed action or transaction upon finding that it is in the best interest of the corporation.  The board shall consider whether the terms of the proposed transaction are fair and reasonable to the organization and whether it would be possible, with reasonable effort, to find a more advantageous arrangement with an entity that is not an interested party. 
Approval by the disinterested members of the board of directors shall be by vote or a majority of directors in attendance at a meeting at which a quorum is present.  An interested party shall not be counted for purposed of determining whether a quorum is present, or for purposes of determining what constitutes a majority vote of directors in attendance.  The minutes of the meeting shall reflect that the conflict disclosure was made, the vote taken and, where applicable, the abstention from voting and participation by the interested party.

VIOLATIONS OF CONFLICT-OF-INTEREST POLICY
If the board of directors has reason to believe that Staff has failed to disclose an actual or potential conflict
of interest, it shall inform the person of the basis for such belief and take the appropriate action.

COMPLAINT PROCESS
Occasionally, customers of NHS may not be satisfied with the level of service provided and may wish to file a formal complaint. If the nature of the complaint deals with the services provided by a third party, such as a lender or contractor, then the complaint should be submitted directly to the appropriate party with a copy to NHS.  While we are not able to exert influence over third party providers, we are always striving to work with only those businesses that provide the highest quality of service to our customers.  

If your complaint deals specifically with NHS, the following steps must be taken:  You must provide, in writing, a complete explanation outlining the nature of the complaint including any NHS employees involved.  You must provide a phone number where you may be reached during the day should additional questions be necessary.  The written complaint must be delivered, either via mail or in person, to the attention of the Chief Operating Officer of NHS of Baltimore at 25 E 20th Street, Suite 170, Baltimore, MD 21218.  Upon receipt of your complaint, the Chief Operating Officer will investigate and respond in writing within ten (10) days. 

If your complaint is not resolved to your satisfaction, you may request a review by the Executive Director of NHS.  The request for the Executive Director’s review must also be made in writing and delivered to the address listed above. Upon receipt of the request, the Executive Director will review the complaint and issue a written response within ten (10) days.  The decision of the Executive Director shall be viewed as final.

CONFLICT OF INTEREST POLICY AND COMPLAINT PROCESS: DISCLOSURE STATEMENT
By signing below, I hereby affirm that I have received the Conflict-of-Interest Policy for staff, customers and volunteers of NHS of Baltimore, Inc. (NHS).  I have also been advised that NHS’ activities include the purchase, sales and rehabilitation of properties, and that I, as a customer, are under no obligation to sell to, or purchase, or use the rehabilitation services of NHS.  I further understand that NHS, Inc. is a charitable organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes.  Lastly, I’ve been provided a copy of NHS' Customer Complaint process and understand the steps I must take to submit a complaint.







Homeownership Counseling Agencies Resource Referral
Belair Edison Housing Services 

3412 Belair Road 

Baltimore, MD 21213 

Phone 410-485-8422


Druid Heights CDC 

2140 McCulloh Street 

Baltimore, MD 21217 

Phone 410-523-1350


Garwyn Oaks Housing Resource Center

2300 Garrison Boulevard, Suite 211

Baltimore, MD 21216 

Phone 410-947-0084


Harbel Housing Partnership 

5807 Harford Road 

Baltimore, MD 21214 

Phone 410-444-1400


HomeFree-USA

8401 Corporate Drive, Suite 600 

Landover, MD 20785

Phone 855-493-4002 


Latino Economic Development Center 

3500 Boston St., Suite 227

Baltimore, MD 21224

Phone 410-578-7190


NHS of Baltimore 

25 E 20th Street, Suite 170 

Baltimore, MD 21218 

Phone 410-327-1200


Southeast CDC 

3700 Eastern Avenue 

Baltimore, MD 21224 

Phone 410-342-3234


St. Ambrose Housing Aid Center

321 E 25th Street

Baltimore, MD 21218 

Phone 410-366-8550