Closing Cost Assistance Grant Program

APPLICATION INFORMATION

Cell Phone

Please enter a valid phone number

How did you hear about this program? *

Other- How did you hear about this program?

Are you related to or do you have business ties to any VAREP staff, members of their immediate families, VAREP Board members, members of their immediate families, and such individual's business associates? *

Yes

MILITARY & HERO DETAILS

Branch of Service/ Hero Affiliation *

Military Status *

Pay Grade

Dates of deployments/ When will you deploy/ Location of deployments

Have you applied for financial assistance in the past 12 months? *

Yes

Name of Organization

Amount of Assistance

What unforeseen situation occurred that caused your need for applying?

Provide a detailed plan on how you will maintain future financial responsibilities if a grant were to be awarded:

Family Status *

Married

Single

Divorced

Widowed

Member 1- add Name, Age, and Relation to Applicant

Member 2- add Name, Age, and Relation to Applicant

Member 3- add Name, Age, and Relation to Applicant

Member 4- add Name, Age, and Relation to Applicant

Member 5- add Name, Age, and Relation to Applicant

Are you currently Employed *

Yes

Employer Name (If Yes)

Supervisor Name- If Employed

Supervisor Phone- If Employed

Income- Monthly Gross Amount *

Primary Employment (Gross)
Spouse/Co-Borrower Employment (Gross)
Self-Employment / Business Income
Retirement / Pension
Social Security
Child Support / Alimony
Other Regular Income
VA Service-Connected VA Disability (if applicable)

If other was selected, please explain

Total Monthly Household Income (all sources) *

Expenses-Monthly Amount

Current Rent or Mortgage
Property Taxes (if separate)
Homeowners/Renters Insurance
HOA Dues
Utilities (electric, gas, water, trash)
Auto Loans/Leases
Credit Cards (minimum payments)
Student Loans
Personal Loans
Childcare
Child Support/Alimony Paid
Food & Household Supplies
Transportation & Fuel
Medical/Insurance Out-of-Pocket
Other Monthly Obligations

If other was selected, please explain

Total Monthly Household Income (all sources) *

Liquid Assets

Please list current balances. Enter $0 if not applicable.

Asset Type- Current Balance ($)

Checking Account(s)
Savings Account(s)
Money Market Account(s)
Cash on Hand

Total Liquid Assets:

CLOSING COST ASSESSMENT

Transactional Information *

Expected Closing Date
Liquid Funds Available for Closing
Estimated Total Closing Costs:
Amount I Can Contribute:
Grant Amount Requested ($1.00 - $5,000 max)::

Loan Type *

If other was selected, please explain

Primary reason assistance is needed *Check all that apply

If other was selected, please explain

Briefly describe your situation and why this grant is needed *

Title/Closing Company Name

Escrow/Reference Number

Real Estate Company Name

REFERENCES- LIST 2 REFERENCES

Reference 1 Name *

First

Phone (Reference 1) *

Reference 2 Name *

First

Phone (Reference 2) *

Calloway Closing Cost Documents

Please Download the document below, read it carefully, sign the document, and upload the documents with other required supporting documents int the next section.

· Calloway Closing Cost Policy

Calloway Closing Cost Policy (signed) *