City of Tampa Home Buyer Education Application

I/we hereby authorize Tampa Bay Neighborhood Housing Services to obtain all information necessary, including a credit report, to assist me/us in an evaluation of our capacity to successfully accomplish, or maintain homeownership. I understand that depending on the type of service received, the information may be shared with state, county, and city representatives, as well as, realtors and/or lenders in an effort to determine eligibility for mortgage financing, and develop a plan to correct qualification deficiencies in the pursuit of mortgage approval.

I/We, the undersigned, certify under penalty of perjury that the information provided here is true and correct, to the best of my
knowledge and recollection. WARNING: Anyone who knowingly submits a false claim or knowingly makes a false statement is
subject to criminal and/ or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties.

I/we further authorize our first mortgage lender, Closing Title Company and/or realtor to provide TBNHS with copies of the Closing Disclosure and any other documents from my/our mortgage or real estate file that would assist Tampa Bay Neighborhood Housing Services and/or Neighborhood Home Solutions in the completion of my file.

Tampa Bay Neighborhood Housing Services (TBNHS) – Disclosure Form NOTE: If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about housing counseling, please talk to your housing counselor about arranging alternative accommodations.

About Us and Program Purpose: (TBNHS) is a nonprofit, HUD-approved housing counseling agency. We provide educational workshops and a full spectrum of housing counseling services including pre-purchase, financial management, budget, credit repair, foreclosure prevention, and non-delinquency post-purchase counseling. TBNHS, builds, rents, and sells affordable housing. 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.

Counselor’s Roles and Responsibilities: Review your housing goal and your finances; which include your income, debts, assets, and credit history. Preparing a Client Action Plan that lists the steps that you and your counselor will take in order to achieve your housing goal. Preparing your household budget helps you manage your debt, expenses, and savings. Your Counselor is not responsible for achieving your housing goal but will provide guidance and education in support of your goal. Neither your counselor, nor TBNHS employees, agents, or directors may provide legal advice.

Client's Role and Responsibilities: Completing the steps assigned to you in your Client Action Plan. Providing accurate information about your income, debts, expenses, credit, and employment. Attending meetings, returning calls, and providing requested paperwork in a timely manner. Notifying TBNHS or your counselor when changing housing goals. Attending education workshop (i.e., prepurchase counseling workshop) as recommended. Retaining an attorney if seeking legal advice and/ or representation in matters such as foreclosure or bankruptcy protection.

Termination of Services: Failure to work cooperatively with your counselor and/ or TBNHS will result in the discontinuation of counseling services. This includes but is not limited to, missing appointments.

Agency Conduct: No TBNHS employee, officer, director, contractor, 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 Relationships: TBNHS has a financial affiliation with HUD, NeighborWorks America, Homefree USA, Florida Housing Finance Corporation, Pinellas County, Pasco County, the City of Clearwater, the City of Largo, and the City of St. Petersburg, and banks including but not limited to Third Federal Savings and Loan, TD Bank, Bay First, Bank of America, Wells Fargo, Raymond James. I agree that TBNHS may release information to the proper officials, in compliance with these contracts.

Alternative Services, Programs, and Products & Client Freedom of Choice: You are not obligated to participate in or use any programs and/ or services while you are receiving housing counseling from our agency. Your participation in a TBNHS program does not obligate or require you to use any series or products that may be suggested, offered, or recommended by TBNHS. You are entitled to choose whatever real estate professionals, lenders, and lending products that best meet your needs.

Referrals and Community Resources: If asked for you will be provided with information about regional services available to meet a variety of needs, including utility assistance, emergency shelter, transitional housing, food bank, and legal aid assistance.

Privacy Policy: I/We acknowledge that I/ We received a copy of TBNHS’s disclosures herein and I/We agree that TBNHS, its employees, agents, and directors are not liable for any claims and causes of action arising from errors or omissions by such parties or related to my participation in TBNHS counseling, and I hereby release and waive all claims of action against TBNHS and its affiliates. I have read this document, understand that I have given up substantial rights by signing it, 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.

Quality Assurance: In order to assess client satisfaction and in compliance with grant funding requirements, TBNHS, 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 TBNHS’s grantors such as HUD or NeighborWorks America.

Authorization to Release Information: I/we hereby authorize TBNHS to obtain all information necessary, including a credit report, to assist me/us in an evaluation of our capacity to successfully accomplish, or maintain homeownership. I understand that depending on the type of service received, the information may be shared with state, county, and city representatives, as well as, realtors and/or lenders in an effort to determine eligibility for mortgage financing, and develop a plan to correct qualification deficiencies in the pursuit of mortgage approval.
I/we further authorize our first mortgage lender Closing Title Company and/or realtor to provide TBNHS with copies of any documents from my/our mortgage or real estate file that would assist TBNHS in the completion of my file.

Home Inspection Materials: (Home Buyer Education and/ or Pre-Purchase Counseling Only). By signing below, I/ We certify that I/ We will receive the following materials: “For Your Protection Get a Home Inspection” and “Ten Important Questions to Ask a Home Inspector” in the Home Buyer Education Class that I attend. Unless seeking services other than Home Buyer Education or Pre-Purchase counseling in which case these materials are not applicable.
By signing below, I/ We acknowledge that I/We received, reviewed, and agree to TBNHS’s Program Disclosures as provided herein.

Each participant in the above-referenced training sponsored by Tampa Bay Neighborhood Housing Services (TBNHS) is required to put in eight hours of class time. Failure to do so will require:
1. Makeup up of missed time in order to receive a Certificate of Completion.
2. If more than 1 hour is missed you will have to reschedule for another date.

CONSENT AND RELEASE For good and valuable consideration, I (on my own behalf and on behalf of any minor of whom I am the parent or guardian) (the “Subject(s)”) grant to TBNHS and its affiliates and their representatives, employees, officers, directors, agents, successors and assigns (collectively, “TBNHS”) the consents, waivers, and releases set forth below. I am (and the minors, if any, identified below, are) voluntarily participating in various TBNHS promotional and marketing activities (collectively the “Activity”) and understand that photographs, video, digital images, and recordings will be made during or in connection with any Activity and that my or our image, voice, statements and likeness (the “Images”) may be used, published and displayed by TBNHS and its advertising and marketing agencies for marketing, publicity, educational, promotional and other commercial purposes as determined by TBNHS or its advertising and marketing agencies.

Consent and Release. I hereby unconditionally and irrevocably grant TBNHS and its agents and licensees, the right to take and create the Images and the right to use, publish, reproduce, and disseminate the Images, including my name, likeness, recorded voice, and all other Images captured or provided in connection with the Activity. I hereby grant to TBNHS, irrevocably, worldwide, and in perpetuity, all rights, titles, and interests of every kind in and to the Images, including the entire copyright and all intellectual property rights in and to the works and materials comprising, derived from, or embodying the Images. I understand that the Images may be edited, cropped, modified, digitized, combined, reproduced, translated, broadcast, displayed, published, and presented in public and in any and all media, including, without limitation, print, radio, television, posters, billboards, electronic, digital, mobile and social media, and the Internet. I understand that this grant of rights, permission, and publicity release is intended to be as broad as the law allows, and I agree to execute any further documentation to evidence such a grant of rights as requested by TBNHS.

Waiver of Claims. I hereby waive any right to inspect, review, or approve the finished Images or printed or electronic works or materials that may be used in conjunction with the Images now or in the future, whether or not such use is known to me, and expressly waive all intellectual property rights, including any moral rights, and waive any right to royalties, payments, or compensation of any kind arising from or relating to the publication or use of the Images. I understand that there is no time limit on the validity of this grant of rights and publicity release nor is there any geographic limitation or restriction on TBNHS’s use of the Images. I hereby release and discharge TBNHS and its advertising and promotion agencies, and each of their respective officers, directors, employees, agents, successors and assigns from any and all liabilities, claims, demands, actions, damages, expenses, costs, and fees (including attorney fees) whatsoever, whether now existing or hereafter arising, in connection with or relating to the Activity and any use or publication of the Images including, without limitation, claims of personal injury, infringement, invasion of privacy, emotional distress, or defamation, and whether or not such claims arise from the negligence of TBNHS.