Counseling Intake:  Personal Information Form 

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Please upload all required materials listed below. Note: We are unable to accept you into the Home Journey Counseling Program if we do not receive all program application materials required in this form. Please upload documents in original PDF format or scan them. Documents need to be clear, legible and in color. We cannot accept pictures of documents, screenshots or documents that require a password. These documents will be rejected upon review. 










Counseling Intake Form

Please upload your completed Counseling Intake Form. Please ensure it is legible and ALL applicable fields are completed. This includes entering the date when you sign. Please DO NOT upload each page separately - scan as one document. You are welcome to complete the Counseling Intake Form digitally or by printing and writing by hand. 

The Counseling Intake Form can be found here:  Counseling Intake Form



In order for us to verify your identity, please upload a photo or scan of your current State-issued photo identification card. We will need photo ID for Applicants, Co-Applicants, and all household members 18 years or older. 

In order for us to verify your identity, please upload a photo or scan of your Social Security card. We require SSN cards for ALL household members, regardless of age. 

In order for us to verify your identity, please upload a photo or scan of your Permanent resident card (if applicable). If you have an ITIN and have applied for Permanent Residency (I-485), please upload proof of this application.


Proof of income for all applicants and household members: 

30 days of your most recent, consecutive pay stubs (Applicants, Co-Applicants & household members 18 years and older) 

Proof of additional income such as Social Security, child support, alimony, survivor’s benefits, disability, adoption subsidy, etc. for all household members. *This documentation needs to be in the form of official government or agency-issued verification

To obtain proof of income for Social Security benefits: socialsecurity.gov or 1.800.772.1213 
To obtain proof of income from child support in Nebraska: childsupport.nebraska.gov or 1.877.631.9973


Applicants & Co-Applicants: Please upload your two (2) most recent bank statements for all Checking and/or Savings accounts. Please note that we need the full statements. 



Applicants & Co-Applicants:

Please upload your 2022, 2023 and 2024 W-2s, 1099s, etc. (These are the documents provided to you by your employer by January 31st, and reflect your annual wage and income) 

Please upload your two (2) most recent years of Tax Return Transcripts. *Please note that we no longer accept 1040 tax return forms, and we require you to provide your Tax Return Transcript directly from the IRS. These can be retrieved at https://www.irs.gov/individuals/get-transcript or by calling 800 908 9946 to request by mail.  

Please note that the current tax season ends on April 15th, and having your two most recent years filed is required to be considered for our program. 


About your Personal Information
Habitat for Humanity of Omaha Privacy Statement and Notice

At Habitat for Humanity of Omaha, we are committed to keeping your information private. We recognize the importance applicants, program families, tenants, and homeowners place on the privacy and confidentiality of their information. While new technologies allow us to more efficiently serve our customers, we are committed to maintaining privacy standards that are synonymous with our established and trusted name.

When collecting, storing, and retrieving applicant, program family, and homeowner data – such as tax returns, pay stubs, credit reports, employment verifications and payment history – internal controls are maintained throughout the process to ensure security and confidentiality. We collect nonpublic personal information about you from the following sources: 

Information we receive from you on applications or other forms; Information about your transactions with us or others; and Information we receive from a consumer reporting agency. We may disclose the following kinds of nonpublic personal information about you: 

Information we receive from you on applications or other forms, such as Name, address, social security number, income, etc.

Information about your transactions with us or others such as you’re your loan balance and payment history.

Information we receive from a consumer reporting agency such as your credit history. Habitat for Humanity of Omaha employees and volunteers are subject to a written policy regarding confidentiality, and access to applicant data is restricted to staff and volunteers on an as-needed basis. Information is used for lawful business purposes and is never shared with third parties without your consent, except as permitted by law.

As permitted by law, we may disclose nonpublic personal information about you to the following types of third parties:

Financial service providers, such as mortgage servicing agents.

Nonprofit organizations, government entities, or other subsidy providers. If you prefer that we do not disclose non-public personal information about you to nonaffiliated third parties, you may opt out of those disclosures, that is, you may direct us not to make those disclosures (other than disclosures permitted by law). If you wish to opt out of disclosures to nonaffiliated third parties, you may call Habitat for Humanity Omaha Inc. at 402-457-5757. (HFHI)

We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmation advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status, national origin, creed or age. 11/2/2022
How we will process your request

How we will process your request


After you have submitted all of the above required Home Journey Counseling Program application materials, our team will contact you regarding next steps. This review will determine if you are eligible to enter our Home Journey Counseling Program. 

We will answer your request or request additional information from you within 30 days. 

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