Welcome to the Intake Center

Please complete this page as thoroughly as possible.  The information requested is for our Housing and Urban Development (HUD) compliance.  Our team will review and communicate any information needing clarification.

An incomplete intake will need to be remedied before ANY service(s) are given.

Only ONE PARTICIPANT per intake.

General Information
Household Information

Income is based on the family unit.  If you live with other relatives, then only add your spouse and dependent income to yours.

Are you currently Employed?

No | Yes


Do you have a disability?

If YES, Job Title:  


Does your spouse or a dependent have a disability?

No | Yes

Demographic Information

Are you Hispanic?

Are you proficient in English?

Are you a Veteran?

Do you Live in a rural area?

An area having less than 2,500 inhabitants.

Like Alpine or Julian


Are you foreign born?

Are you the Head of Household?

Are you active military?

Are you a First-time home buyer?

Not having owned, had investment interest, or been on title of a property for over 3 years.

Are you an Essential Worker?

If Essential Worker:

Class or Individual Disclosure and Conflict of Interest Policy Statement


  1. ULSDC provides information and education on numerous loan products, housing programs and other programs.  ULSDC provides the following services: Education (financial literacy, homebuyer education, post-purchase workshops), Counseling (pre-purchase & post-purchase counseling including Foreclosure Counseling, Youth Education & Employment Training, Work Readiness, Elderly Health Access and Civic Engagement. The information that is received from the ULSDC in no way obligates our client(s) to choose any particular product(s) or housing program that is presented.

  2. ULSDC program administrators and/or their agents may follow-up with their client(s) for the purpose of program monitoring and evaluation.  ULSDC collects demographic data, and may be asked to share this information with their funders.

  3. Client (s) acknowledges that they have received a copy of handout “For Your Protection Get a Home Inspection” and the “Ten Important Questions to Ask A Home Inspector”.  Download Here

  4. ULSDC Housing and Financial Capabilities Program has financial relationships with outside funders.  ULSDC client(s) are not obligated to use any of the services provided by their funders.  ULSDC Financial Capabilities Program Funders include: National Urban League (HUD Comprehensive Housing Counseling), Wells Fargo Bank, Union Bank, JP Morgan Chase, Citibank, UNIDOS, CalHFA (California Housing Finance Agency), Private Donations and/or Public Grants.

  5. Instructors and/or counselors may answer questions and provide information, but not give legal advice.  If our client(s) want legal advice, they will be referred to another agency for appropriate assistance.  Client(s) are encouraged to promptly consult with service providers, agencies, organizations, or any other legal referral sources to which the client(s) have been referred to follow-up on their potential legal issues.

  6. Our client(s) may be referred to other services of this organization, another agency or agencies as appropriate that may be able to assist our client(s) further, with their particular concern(s) that have been identified.  ULSDC client(s) are not obligated to use any of the services that are presented.

  7. ULSDC prohibits the following actions in order to prevent a conflict of interest in provision of its Housing, Financial Capabilities and Education services.

    • ULSDC will ensure and monitor that the agency, its staff, or any member of their immediate family must not take any action that may result in, or create the appearance of administering the Housing and Financial Capabilities program for personal or private gain; providing preferential treatment to any organization or person; or undertaking any action that might compromise the agency’s ability to ensure compliance with HUD program requirements, or to serve the best interests of its client(s).

    • Individual directors or employees, or family members of the ULSDC may not accept a fee or any other consideration for referring a client(s) to mortgage lenders, brokers, builders, or real estate sales agents.

    • Director, employee, officer, contractor, or agent of the ULSDC shall not refer client(s) to mortgage lenders, broker, builder’s or real estate agent in which the officer, employee, director, his spouse, child, or general partner has a financial interest, neither may they acquire the client’s property from the trustee in bankruptcy or accept a fee or any other consideration for referring a client(s) to mortgage lenders, brokers, builders, or real estate sales agents or brokers.

    • Director, employee, officer, contractor, agent, his or her spouse, child, general partner or organization in which he or she serves as employee (other than with the ULSDC), or with whom he or she is negotiating future employment, may not have a direct interest in the client(s) as a landlord, broker, or creditor, or originate, have a financial interest in, service, or underwrite a mortgage on the clients’ property, own or purchase a property that the client(s) seeks to rent or purchase, or serve as a collection agent for the client’s mortgage lender, landlord, or creditor.

I understand that by typing my name (as my signature) and dating this section, that I acknowledge that I have read and understand what the Class or individual Disclosure and Conflict of Interest Policy is stating.


We at Urban League of San Diego County committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. Your “nonpublic personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your authorization and signature on the second page of this form. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs.

Information We Collect

We collect personal information to support our Housing and Financial Capabilities operations and to aid you in shopping for a home mortgage or sustaining your home mortgage. We collect personal information about you from the following sources:

  • Information that we receive from you on intake or other forms,

  • Information about your transactions with us, our affiliates or others,

  • Information we receive from a consumer reporting agency, and

  • Information that we receive from personal and employment references.

Information We Disclose

We may disclose the following kinds of personal information about you:

  • Information we receive from you orally, on applications or other forms, such as your name, address, social security number, employer, occupation, assets, debts and income;

  • Information about your transactions with us, your creditors, our affiliates or others, such as your account balance, payment history, parties to your transactions and credit card usage; and

  • Information we receive from a credit reporting agency, such as your credit bureau reports, your credit history and your creditworthiness.

To Whom Do We Disclose

So long as you have not opted-out, we may disclose some or all of your personal information that we collect to the following types of unaffiliated third parties:

  • Financial service providers, such as companies engaged in providing home mortgage or home equity loans,

  • To your creditors or third parties where we have determined that it would be helpful to you, would aid us in counseling/coaching you to reach your housing goal, or is a requirement of grant awards which make our services possible.

  • We may also disclose any nonpublic personal information about you or former customers to anyone as permitted by law (e.g., if we are compelled by legal process).

Others, such as nonprofit organizations involved in community development, but only for program review, auditing, research and oversight purposes.

Prior to sharing personal information with unaffiliated third parties, except as described in this policy, we will give you an opportunity to direct that such information NOT be disclosed.

I have read and understand the Privacy Policy and Practices

Confidentiality and Security

We restrict access to personal information about you to only those employees who need to know that information to provide products and services to you and to help them do their jobs, including underwriting and servicing of loans, making loan decisions, aiding you in obtaining loans from others, and financial counseling. We maintain physical and electronic security procedures to safeguard the confidentiality and integrity of personal information in our possession and to guard against unauthorized access. We use locked files, user authentication and detection software to protect your information. Our safeguards comply with federal regulations to guard your personal information.

You may opt-out of certain disclosures

  1. You have the opportunity to “opt-out” of disclosures of your nonpublic personal information to third parties (such as your creditors), that is, direct us not to make those disclosures.

  2. You may opt-out of this requirement, but proof of your decision to opt-out must be recorded in your client file.

  3. If you choose to “opt-out”, we will not be able to answer questions from your creditors. If at any time, you wish to change your decision with regard to your “opt-out”, you may call us at 619-266-6256 and do so.

If you want to opt out, that is, direct us not to make disclosures about your personal information (other than disclosures permitted by law) as described in this notice, check the box below to indicate you want to opt-out AND check the box that you have read and understand our privacy policy and practices statement. 

I want to Opt-Out

No | Yes

Selecting YES means, that if in the event, YOU would like ULSDC to disclose your information to a third party (for example, a lender), we will not have the permission to do so... Now or in the future.

I have read and understand the Opt-Out criteria

The demographic information is requested by the Federal Government for certain types of loan applications and other programs, in order to monitor compliance with equal credit opportunity, federal civil rights laws, fair housing and home mortgage disclosure laws and for our own statistical monitoring. You are not required to furnish this information, but are encouraged to do so. By providing this information, you will assist us in assuring that this program is administered in a non-discriminatory manner. All answers are kept strictly confidential.

The Urban League of San Diego County collects information about the people we serve in a computer system called CounselorMAX (CMAX). We collect and maintain client information in a private and secure computer system. People who work for ULSDC will use this information to help provide and track services for you or your family. This information may be shared with auditors or others who have legal rights to review the work of this agency, including private and public funders. All employees using the CMAX system must sign an agreement to protect your privacy before seeing any client information. Your private identifying information will never appear in reports.


I understand that information about services provided to me may be used to conduct research and reporting, related to service needs, income supports, education, employment, and program effectiveness. The use of this information for research and reporting may last beyond the actual delivery of current services provided. My name, social security number, or other information that would identify me personally will never appear on research or a report. I also understand that my phone number, email, or address may be used by ULSDC to contact me about upcoming classes or regarding my progress toward my goals. ULSDC will always provide a method to opt out of calls or emails. My typed name (as my signature) shows that I permit ULSDC to enter my personal information into CMAX and receive contact from ULSDC via phone or email, with the option to opt out.


I grant to ULSDC, its representatives and employees the right to take photographs or screen captures of me and my property in connection with coaching, counseling and/or workshop subject matter.  I authorize ULSDC, its assigns and transferees to copyright, use, and/or publish the same in print and/or electronic form.


I agree that ULSDC may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and/or online content.


I certify that all information supplied in this intake web page is true and correct to the best of my knowledge. I understand that false or misleading information may result in an incorrect analysis of my financial situation when researching and/or reporting. I also understand that at the completion of this program I am not guaranteed the purchase of a home, refinance, or receive any mortgage workout.

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