Page 8 - TBRA_Intake
P. 8
I. CURRENT EMPLOYMENT INFORMATION (Continued)
2. Household Member Name: Occupation: Work Phone: ( ) ‐
Employer Name and Address: City: State: Zip Code:
Date Hired: Salary: Pay Period: Hourly Weekly Bi‐weekly (26) Hours worked Fax:
Other per week: ( ) ‐
$ {} Monthly Annually
Twice month(24) Occupation:
Work Phone: ( ) ‐
3. Household Member Name:
Employer Name and Address: City: State: Zip Code:
Date Hired: Salary: Pay Period: Hourly Weekly Bi‐weekly (26) Hours worked Fax:
Other per week: ( ) ‐
$ {} Monthly Annually
Twice month(24) Occupation:
Work Phone: ( ) ‐
4. Household Member Name:
Employer Name and Address: City: State: Zip Code:
Date Hired: Salary: Pay Period: Hourly Weekly Bi‐weekly (26) Hours worked Fax:
{} per week: ( ) ‐
$
Twice month(24) Monthly Annually Other
J. ASSETS OF ALL HOUSEHOLD MEMBERS
(When listing the cash value of any asset marked with an asterisk (*), indicate the amount you would have if you were to convert the asset to cash (i.e. sell or
exchange the asset), deducting any penalties for early withdrawal, amounts used to pay off a balance, and any fees which may be assessed for the conversion.)
Identify All Asset Sources Cash Asset Income Name of Account
Value Number
(Interest/Dividends) Financial Institution
1. Checking Account #1 No Yes $ $
2. Checking Account #2 No Yes $ $
3. Savings Account #1 No Yes $ $
4. Savings Account #2 No Yes $ $
5. Credit Union Account(s) No Yes $ $
6. Stocks, Bonds, Mutual Funds* No Yes $ $
7. Real Estate/Home* No Yes $ $
8. Real Estate/Land* No Yes $ $
9. IRA/Keogh Account(s)* No Yes $ $
10. Retirement/Pension Fund(s)* No Yes $ $
11. Trust Fund(s) No Yes $ $
12. Mortgage Note Held No Yes $ $
13. Whole Life Insurance* No Yes $ $
No Yes $ $
14. Personal Property Held as an
Investment (gems, coins, etc.) No Yes $ $
15. Lump Sums Received No Yes $ $
(inheritance, capital gains,
insurance, etc.)
16. Other:
TDHCA HOME Investment Partnerships Program March 2015
HOME Program Intake Application Page 4 
