Lender Intake Form

Appendix A. Lender Intake Form

HUD’s Pre-Purchase Homeownership Counseling Demonstration and Impact Evaluation

Lender Intake Form

Information about Lender

1. Lender’s Name

2. MSA

Data Transfer Date

Information about Client

1. Client’s First Name

2. Client’s Last Name

3. Address, City, State, Zip

4. Preferred Phone Number

5. Alternative Phone Number

6. Email

7. Date of Birth

8. Date customer gave consent for contact information to be sent to the study team

9. Date customer first contacted lender about home loan

10. Unique CustomerIdentifier

11. First-time homebuyer status

12. Presence of a coborrower

13. Name and first-time homebuyer status of coborrower(s)

14. Language preference: English or Spanish

Pre-Purchase Homeownership Counseling Demonstration and Impact Evaluation  ▌pg. 2