Employer-Assisted Housing (EAH) Loan Application
Date of filing:
By signing the Application, I acknowledge that I received, read and understand the EAH
Benefit policy, and agree to comply with the terms and conditions of the policy.
EMPLOYEE INFORMATION (please print)
Name: SSN:
Department: Hire date:
Title: E-mail:
Home phone: Work phone:
Current address:
I am applying for the following EHP Benefit Loan:
Property to be Purchased
Address:
Purchase Price $ (attach a copy of fully executed Property Purchase Contract)
The Closing Date is scheduled for
MORTGAGE LENDER(S) INFORMATION (if applicable)
Lender Name:
Address:
Contact Name: Phone:
E-mail: Fax:
Subordinate Lender Name (if applicable):
Address:
Contact Name: Phone:
E-mail: Fax:
[ ] Standard EAH Benefit
[ ] Other
[ ] Conditional Reservation
in the amount of $
in the amount of $
in the amount of $
REPRESENTATIONS
I represent, promise and confirm that I am eligible for the EHP benefit described in this
application and:
As of the date of this application, I am an active, full-time employee in good
standing at the university (and not involved in the disciplinary action or progressive
counseling processes).
I have completed my 90-day introductory period.
I am purchasing a property in the City of Wilkes-Barre.
I will use the Loan proceeds of this loan only for the following purposes:
o Partial payment of the Property Purchase Price
o Permanent interest rate buy down on my Relate Mortgage
o Closing costs on my Related Mortgage
I will occupy the Property as my primary residence within a reasonable period of
time following the Closing Date, but in no event more than 90 days following the
Closing Date.
No one who will be an owner of the Property, or be liable on a Related Mortgage,
is now an owner of the Property.
The EAH Benefit Loan will be my first and only at Wilkes University.
ACKNOWLEDGMENTS
I am applying for the benefit under the EHP Program. All statements made in this
application are true and correct; this application contains no false statements,
misrepresentations, or omissions of fact; these statements are made with the purpose of
obtaining an EHP benefit under the EHP Program. Any materially false statements,
misrepresentations, or omissions of fact in this application may disqualify me
for an EHP benefit, and may result in disciplinary action, up to and including termination
of my employment.
I authorize the Mortgage Lender(s), Case, or any person designated by Wilkes University
to verify all information I submit in connection with this application. I authorize the release
to Mortgage Lender(s), Wilkes University, or any person designated by Wilkes University
information about me to confirm that I am eligible for an EHP benefit. I authorize the
release of employee certification and related mortgage information to the Mortgage
Lender(s), Wilkes University, or any Person designated by Wilkes University. I authorize
Wilkes University or any person designated by Wilkes University to obtain a consumer
report when administering or collecting any EHP benefit I owe and to obtain any other
information about my income, assets and liabilities.
Deliberate false statements in this application may be a federal crime punishable by fine or
imprisonment, or both under Title 18, United States Code, Section 1014. By signing this
application, I acknowledge that I received, read and understand the EAH Benefit policy
and agree to comply with the terms and conditions of the program.
Employee Signature: Date: