Housing Counseling

Housing Counseling Intake Form

Application for Housing Counseling Services
  • Part One: Biographic and Demographic Info

  • Last, First, Middle
  • Address and Apartment #, City, State, Zip Code
  • Email Address
  • Mobile, Home, Work
  • Specify primary and or secondary language spoken.
  • Number of people living in the household.
  • NameAgeGender (M/F)RelationshipDependent (Y/N) 
    All parties living in the household
  • Part Two: Employment Status Info

    Last 2 years
  • Date Format: MM slash DD slash YYYY
    (Start date-End Date )
  • Date Format: MM slash DD slash YYYY
    (Start Date-End Date)
  • Part Three: Housing Status and Housing Goals

  • Part Four: Rental or Mortgage Info

  • If you own your property answer the following Section.

  • Part Five: Credit, Income, Debt and Monthly Expenses

  • Monthly
  • Monthly
  • Monthly
  • Monthly
  • Monthly
  • Monthly
  • Monthly
  • Monthly
  • Monthly
  • Debt

    Monthly
  • (Amount Paid)
  • (Tot. of current medical bills)
  • (Electric, Water, Gas, Cable, Internet (wifi)
The Housing Counseling Program provides first-time home-buyer classes and individual counseling sessions, mortgage delinquency & default resolution counseling, financial management/budget counseling and Georgia Dream Down Payment Assistance to help families improve their credit.