HFLA (Hebrew Free Loan Association) is a nonprofit organization that provides interest-free loans to individuals who face financial hurdles and are unable to access other resources to address those needs. We hope this loan will help individuals address immediate needs, and prevent an individual from seeking other lending sources that would create further financial distress.

As a lending institution, we will use your financial information to understand your ability to repay a loan. We differ from traditional lenders by using a lot of factors as we consider your loan application. We hope you will use the space below to tell us about you, your needs, and how this loan will assist you in addressing your needs and/or getting on a path to financial security.

If you would like additional information about HFLA of Northeast Ohio and the application process, please see our FAQs on our website here:

https://interestfree.org/loans/faqs/

Please answer the following questions completely.

Source of Referral

Personal Information

First Name

Last Name

Email

Phone Number

Social Security Number

Date of Birth

Street Address

City

State

Zip Code

Name of Training Program and School

Current Employer

Years at Company

Amount Requested

Purpose of Loan

What is the financial need you are facing?

How does this hurdle prevent you from being successful at work?

Are there other resources that could help address this financial need?

If yes, please list.

Is this loan part of your plan to achieve other financial goals?

YesNo

If yes, what is this plan or goal?

Please explain your home repair needs

LISC Home Repair Information

If approved, the total amount provided to homeowners will be split evenly between a 0% interest loan and a grant that does not need to be paid back. For instance, if you are approved for a $10,000 home repair project, $5,000 will need to be repaid to HFLA of Northeast Ohio and $5,000 will be given as a grant that will not need to be repaid. Please type your full name below to indicate that you are aware of this requirement to pay back half of the financing for your project.

First and Last Name

Sources of Income: (Please check all that apply)

Wages, Salary, Tips (typical employment for jobs where income is reported on an IRS Form W-2)Self-Employment Income (business income or contracted work as reported on an IRS Form 1099 and Schedule C)Retirement Income (income received from social security, disability income, pension, and/or annuities)Income from alimony, child support, or maintenance paymentsRental income Other

If you receive income other than what is listed above, please explain.

Total monthly household income (take-home pay, after taxes) for all wage earners contributing to household expenses:

Number of people in the household:

Is there a mortgage on your property?

Are the property taxes up-to-date? If no, is there a payment plan in place?

Explain past due property taxes and payment plan information

HFLA of Northeast Ohio will be filing a lien on the property as security. In order to do that, we require that $150 be paid at the time of closing to cover these costs. Please type your full name below to indicate that you are aware of this requirement.

First and Last Name

Start Form Response ID

Start Response ID NULL?

Source

If you would like additional information about HFLA of Northeast Ohio and the application process,

please see our FAQs on our website here: https://interestfree.org/loans/faqs/

Documents Needed

In order for us to review your loan application, we will need you to provide additional documentation.

Copy of Photo ID

Copy of Social Security Card

Two Most Recent Bank Statements: We ask that you provide this statement from your primary financial institution. This, along with your budget, will help us determine your ability to repay this loan.

Bank Statements (continued- only if more space is needed)

Proof of Income: Two most recent paystubs, social security benefits letter, pension statement, and/or evidence of rental income

Proof of Income (continued- only if more space is needed)

Job Offer Letter

Self Employment Income: two most recent tax returns (IRS Form 1040 with Schedule C or corporate tax returns and 1120s) PLEASE NOTE: It is possible that you may be required to provide your year-to-date profit and loss statement.

Third Party Authorization

Monthly Household Budget

Proof of Ownership (Deed)

Most Recent Utility Bill (water, gas, or electric in homeowner's name showing usage history)

Evidence of Valid Homeowner's Insurance Policy (showing dates of coverage and yearly premium)

Notice of Citation of Violation from City Housing Code (if applicable)

Current Property Tax Statement (or proof of payment plan agreement if property taxes are delinquent)

Additional Documents (if needed)

If you would like additional information about HFLA of Northeast Ohio and the application process,

please see our FAQs on our website here: https://interestfree.org/loans/faqs/

Demographic Information

Demographic information is used by HFLA of Northeast Ohio for the application and reporting of new and existing funding sources. We do not use this information in the decision-making of the loan application. While filling out this section is optional, we do appreciate you taking the time to complete as it gives us important and accurate data on the applicants of our loan funds.

Race

Ethnicity

Gender

Work Status

Religion

Education

Non-Cash Benefits

Disability Status

Citizenship Status

Military Status

Number of Adults in the Household

Number of Children in the Household

Third Party Authorization

I hereby authorize HFLA of Northeast Ohio to discuss and release any and all information regarding my application, credit history, and other documents submitted with my application to the following third party: Road Worthy NEO.

I understand that the information discussed with and released by HFLA of Northeast Ohio may include, but not be limited to my income information, information regarding my ability to repay the loan, and other non-public information. I acknowledge that should I wish to terminate this authorization, I must submit the request in writing to HFLA of Northeast Ohio.

Borrower Signature

Date

Third Party Authorization

I hereby authorize HFLA of Northeast Ohio to discuss and release any and all information regarding my application, credit history, and other documents submitted with my application to the following third party: Bridges @ Work.

I understand that the information discussed with and released by HFLA of Northeast Ohio may include, but not be limited to my income information, information regarding my ability to repay the loan, and other non-public information. I acknowledge that should I wish to terminate this authorization, I must submit the request in writing to HFLA of Northeast Ohio.

Borrower Signature

Date

Third Party Authorization

I hereby authorize HFLA of Northeast Ohio to discuss and release any and all information regarding my application, credit history, and other documents submitted with my application to the following third party: LISC.

I understand that the information discussed with and released by HFLA of Northeast Ohio may include, but not be limited to my income information, information regarding my ability to repay the loan, and other non-public information. I acknowledge that should I wish to terminate this authorization, I must submit the request in writing to HFLA of Northeast Ohio.

Borrower Signature

Date

Privacy & Disclosures

The information in this application is for the purpose of obtaining credit and you are warranting and representing that it is true and correct. In signing this document, any borrower, cosigner, or guarantor agrees to pay all bills upon receipt or statement or as otherwise expressly agreed.

HFLA collects nonpublic personal information about you, the borrower, and any co-borrower, co-signer(s), or guarantor(s). We restrict access to your personal information to process the loan application and collect loan payments. We maintain procedural, physical and electronic safeguards to guard your nonpublic personal information. We do not disclose any nonpublic personal information about you to anyone, except as permitted or required by law. We will continue to adhere to the privacy policies and practices as described in this notice even after you satisfy your loan obligation to us. Your confidence in us is important and we want you to know that your personal information is protected. If you have any questions or concerns, please contact us.

HFLA of Northeast Ohio is a credit reporting agency through the Credit Builders Alliance. HFLA is able assist its borrowers build a positive credit history by having your loan payments reported to the credit bureaus. We can also provide referrals to various nonprofits that offer free credit counseling. It is important to note that if you are late on your payments or default on your loan, it will be reported on your, your co-borrowers', and guarantors' credit reports.

By signing this form, you certify that the information you provide in the application is true, and that you agree with HFLA ’s aforementioned policies.

*By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Borrower Signature*

Date