Counseling Intake Application

As a HUD-certified Housing Counseling Agency, the Veterans Center (“VCATL”) is nonprofit, HUD-approved comprehensive housing counseling agency. We provide free education workshops and a full spectrum of housing counseling including pre-purchase, foreclosure prevention, non-delinquency post-purchase, reverse mortgage, rental and homeless counseling. 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 and initial, sign, and date the form on the following page

I/we acknowledge that I/we received, reviewed, and agree to Veterans Center HCA’s Program Disclosures and telephone counseling

I understand that Veterans Center provides housing stability counseling after which I will receive a written actionplan consisting of recommendations for handling my situation, possibly including referrals to other housingagencies as appropriate.

I agree to allow Veterans Center to pull my credit report at the time of intake. In lieu of a new credit pull, I agree toprovide Veterans Center with a copy of my credit report dated within 30 days of the intake date.

I understand that Veterans Center receives Congressional funds through the Housing Stability Counseling Program(HSCP) and as such, is required to submit client-level information to the online reporting system and share someof my information with HSCP administrators or their agents for purposes of program monitoring, compliance andevaluation.

I give permission for HSCP administrators and/or their agents to follow-up with me between now and June 30,2026, for the purposes of program evaluation.

I may be referred to other housing services of the organization or other agency or agencies as appropriate that may be able to assist with concerns that have been identified. I understand that I am not obligated to use any of the services offered to me.

I acknowledge that I have received a copy of Veterans Center privacy policy.