You Thrive Florida Application for Home Ownership

Have you been referred to us? *

If yes, by whom were you referred? Their title and agency?

First Name applicant #1 *

Last Name *

Middle Initial

Date of Birth * +

Last four digits of your Social *

Marital Status *

Gender *

Home Address *

How long at current residence?

Previous address if under two years

City *

State *

Zip Code *

County *

Mailing Address

City

State

Zip Code

County *

Home Phone * 🛈

Work Phone

Cell Phone

Email Address

First Name applicant #2

Last Name

Middle Initial

Date of Birth +

Last four digits of your Social

Marital Status

Gender

Home Address

How long at current residence?

Previous address if under two years

City

State

Zip Code

County

Mailing Address

City

State

Zip Code

County

Home Phone 🛈

Work Phone

Cell Phone

Email Address

Number of dependants living with you. (Separate each dependant with a coma)

	you must have at least one item
Name	you must have at least one item
DOB	you must have at least one item
Gender	you must have at least one item

Have you been declared bankrupt within the past seven years? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Have you had any property foreclosed on or deeded in lieu of foreclosure in the past seven years? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Are you currently involved in a lawsuit? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title, in lieu of, foreclosure, or judgment? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Are you currently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation or loan guarantee? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Are you paying alimony or child support or separate maintenance? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Are you a cosigner or endorser on any loan? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Are you a US citizen or permanent resident? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Do you have any outstanding judgments because of a court decision against you? *

	Applicant #1			Applicant #2
	yes	no		yes	no
you must have at least one item	yes	no		yes	no

Ethnicity applicant #1 *

Ethnicity applicant #2

Monthly Income applicant #1 *

0/20 characters

Monthly Income applicant #2

0/20 characters

Current job information applicant #1 *

Current job information applicant #2

Applicants Debt #1

	you must have at least one item
Motor Vehicle	you must have at least one item
Boat	you must have at least one item
Furniture	you must have at least one item
Alimony	you must have at least one item
Rent	you must have at least one item
Utilities	you must have at least one item
Insurance	you must have at least one item
Child Care	you must have at least one item
Internet/Cable/Streaming	you must have at least one item
Credit Cards	you must have at least one item
Medical	you must have at least one item

Applicants Debt #2

	you must have at least one item
Motor Vehicle	you must have at least one item
Boat	you must have at least one item
Furniture	you must have at least one item
Alimony	you must have at least one item
Rent	you must have at least one item
Utilities	you must have at least one item
Insurance	you must have at least one item
Child Care	you must have at least one item
Internet/Cable/Streaming	you must have at least one item
Credit Cards	you must have at least one item
Medical	you must have at least one item

Are you, any member of your family, or any of your household members an employee of You Thrive Florida? *

Yes

No

Fraud Statement: The information above is, to the best of my knowledge, true and complete. I understand that priority in providing assistance will be given to those households with the lowest income and greatest need, i.e., those households in which the elderly, disabled, medically needy, or children under the age of 5 reside. I authorize the agency to make benefit payments directly to my energy supplier. I am aware that after I have provided all the information requested, if I am applying for crisis assistance, the agency has 48 hours; 18 hours if my situation is life threatening, to approve or deny my application, and, if I am applying for Home Energy Assistance, the agency has 45 days to approve or deny my application. I am also aware that if I am not approved or denied within the time allowed, or not apprvoed for the correct amount, I have a right to an appeals hearing.

Acceptance of Application to You Thrive Florida: I certify that the guidelines have been explained to me and that I waive the provisions for the privacy act to allow You Thrive Florida to verify income eligibility. I further certify that all information on this application is true and correct.

Applicant Signature applicant #1 *

clear

Date * +

Applicant Signature applicant #2

clear

Date +