Frequently Asked Questions and Quick Tips for the CASA IDA Application
Thank you for dedicating this time to filling out an application for our IDA program. Please rest
assured that all the information entered in this form is safe and confidential. We will use the information you
have provided to determine your eligibility and if approved, to gather your demographic profile and best
contact information. When filling out this application please answer all fields, if a field does not apply to
you please enter N/A. If you would like to complete this application at home please verify with your
specialist how they would like you to return it for their review (i.e. US mail, e-mail, print copy taken to their office
etc).
What if my address is changing or will change in the future?
Please enter your current address and update your specialist of your new address once you have completed your move.
What if the bank I want is not listed in the approved list of Financial Institutions?
We have a specialized contract with each of our partner financial institutions. These are the most qualified and trained
institutions that will be able to assist you with your IDA. At this time please choose a financial institution listed in the
approved list.
Will having a negative Net Worth affect my eligibility for the program?
Having a negative net worth will not affect your eligibility.
What if I have SSI or SSDI?
Please select Other as your income type and enter 0 (zero) as your monthly gross income and annual income. You do
not need to provide a written letter detailing the nature of your income, but please provide your benefit letter. SSI and
SSDI income should not be included in the application but will be used to determine eligibility.
Income Types and Verification of Income
Wages, Salaries- Two months of concurrent pay stubs and previous year's tax return
Self-Employment- Previous year's Schedule C and Three month Cash Flow
Pension- Previous year's tax return
Unemployment- Unemployment Benefit Letter
Work Study- Award Letter
Other- Letter detailing the nature of your work and your gross monthly income.
Other Required Materials
Previous year's Tax Return
Oregon Residency Verification (state ID, driver's license, utility bill, lease agreement etc.)
Quick Tips for this form:
· All of the fields are required. If the field does not apply to you please write N/A.
· Please print this form and fill out by hand; if you would like an online fill-able version of this application please
contact your specialist.
Thanks again, if you have any questions please contact your IDA specialist.
The CASA IDA Team
Application for Participation in
VIDA
or the
Matched College Savings Program (MCSP)
In order for your application to be considered, the following items must be attached for the applicant and all members of the applicant's
household. All fields must be filled in.
Two months concurrent pay stubs
SSI or SSDI benefit letter, proof of unemployment benefits and/or proof of other income (if applicable)
Most recent tax return (including all schedules, if applicable)
Schedule C and current Profit & Loss statement for self employed income
Proof of Oregon residency (Oregon issued ID, utility bill, lease agreement, etc.)
Which IDA provider are you working with?
General Information
Applicant Full Name:
Mailing Address:
City:
State:
SSN or ITIN:
Zip Code:
Primary Phone:
County:
Secondary Phone:
E-mail:
Which asset are you interested in saving for? (Please choose only one):
First Time Home Ownership
Post Secondary Education/ Job Training
Home Repairs or Modifications
Small Business Start Up/Expansion
Equipment, Technology or Specialized Training to Gain/Maintain Employment
If Education, which college/university do you plan to attend?
If Education, will you be a first generation student?
If Business, what do you plan to purchase with your IDA?
Demographic Information
Gender:
Date of Birth:
Marital Status:
Married
Domestic Partnership
Single
Separated
Divorced
Widowed
Ethnicity:
Alaska Native
Asian
Black/African American
Native American
Native Hawaiian or Other Pacific Islander
White Other:
Hispanic:
Yes
No
Country of Origin:
Language for correspondence:
Engish
Spanish
Russian
Other:
Page 1 of 6
Demographic Information (continued)
Household Type:
Single Person
2+ Adults 0 Children
Two Parent Household
Single Mother
Migrant Farmworker
Seasonal Farmworker
Not a Farmworker
Single Father
Other:
Farmworker Status:
Farmworker
Veteran:
Yes
No
Housing Type:
Homeless
Own
Rent
Youth living with family
Group Home
Other
Housing Type if Other:
Youth at Intake?
Yes
No
Foster youth?
Yes
No
Do you identify as having a disability?
Yes
No
Do you live on a reservation?
Yes
No
Which Financial Institution do you want to use?*
*Please refer to the approved list of Financial Institutions; contact your specialist for more
information.
Page 2 of 6
Household Net Worth - Assets and debts for all members of the Applicant's household
Assets
Cash:
Savings Account (not an IDA):
Children's Savings/CDs:
Checking Account:
Please use the tax assessed value, a recent appraisal, or a fair estimate for determining the value of your home(s).
Are you a homeowner?
Value of Home or Condo 1:
Value of Home or Condo 2:
Please use Kelly Blue Book (www.kbb.com), NADA (www.nada.com) or a fair estimate for determining the value of your vehicle(s).
Are you a vehicle owner?
Value of Vehicle 1 (most valuable):
Value of Vehicle 2:
Value of Vehicle 3:
Are you a business owner?
Value of Business Account(s):
Value of Business Assets/Inventory:
Do you own stocks/bonds/401k/etc.?
Value of 401k, or Retirement Accounts:
Value of Stocks/Bonds (not retirement):
Certificates of Deposit:
Value of Other Investments:
Value of Other Assets:
Total Value of All Assets:
Minus Value of Home 1, Car 1 and up to $60,000 of 401k or retirement
accounts:
Total Eligible Assets:
Debts
Please use the balance from your most recent mortgage statement(s). If there are multiple liens on the home, add them together.
Amount owed on Home or Condo 1:
Amount owed on Home or Condo 2:
Please use the balance from your most recent auto loan statement(s).
Amount owed on Vehicle 1:
Amount owed on Vehicle 2:
Amount owed on Vehicle 3:
Amount owed on credit cards:
Amount owed on medical bills:
Amount owed on student loans:
Amount owed to friends/family:
Past Due Child Support:
Unpaid Income or Property Taxes:
Store Credit Debt:
Personal Line of Credit:
Business Debts:
Other Debts:
Total Amount of all Debts:
Minus Debt on Home 1, Car1:
Total Eligible Debts:
Total Eligible Assets:
Total Eligible Debts:
Total Eligible Net Worth:
Page 3 of 6
Household Income- Income from all members of the Applicant's household
How many income earners in the household:
Attach 2 months of concurrent income documentation for all income earners in the household.
Under each income type, please indicate if the income belongs to the "Applicant" or to a "Household Member". Then choose the type of
income and write in the gross monthly and annual amount received. Do this for every member of the household who receives income. If
you have selected Other as your Income Type, please provide a letter detailing the nature of your work and your gross monthly income.
Please attach a separate sheet if more rows are required.
Income Earner
Income Type
Monthly Gross Income
Annual Gross Income
Total Income:
Miscellaneous Information
Have you ever used Direct Deposit:
How many adults, including you if over 18, are in your household:
How many children are in your household:
Total number of people in the household:
Highest level of Education Completed:
Completed grades K-5
Completed grades 6-8
HS Diploma
Some College
GED
Some Graduate School
Current School Enrollment Status:
Employment Status:
Not Enrolled
Some High School
Two-Year Degree
College Graduate
Graduate Degree
Enrolled Part Time
Enrolled Full Time
Employed more than full time(41+hrs/week)
Unemployment-retired
Employed full time(35-40 hrs/week)
Unemployment-looking for work
Employed part tme
Unemployment-volunteer work
Unemployment-disability
Unemployment-unspecified
Student
Are you an employee, family of an employee or volunteer of an agency that currently offers IDAs?
If you said yes to the above question, please indicate which agency:
Are you currently enrolled in an IDA Program?
Have you ever been enrolled in an IDA Program?
Have you applied recently for an IDA account with any other agency?
If yes, with which agency and when:
Page 4 of 6
Supportive Services Received
Have you, or anyone in your household, received any of the following in the last 12 months?:
Federal and/or State Earned Income Tax Credit (EITC):
Not Eligible
Received payments
Eligible, but have not received payments
Unknown
Temporary Assistance for Needy Families (TANF):
TANF Recipient currently
TANF Recipient formerly
Not a TANF Recipient
Unknown
Other Assistance (mark all that apply):
Federal Housing Assistance
Free or Reduced Price School Lunch
Emergency Food Assistance
Food Stamps
WIC
Head Start
Oregon Health Plan
Low Income Energy Assistance
Vocational Rehabilitation Services
Employer Related Daycare
Working Family Child Care Tax Credit
Other Support Services
Current Financial Situation
Have you obtained a credit report within the last year?
Are there any outstanding judgments against you?
Are you party to a lawsuit?
Are you obligated to pay alimony or child support?
IDA accounts are subject to garnishment under the law. If you believe that you might be subject to garnishment, please be advised that
your IDA account may be at risk.
Page 5 of 6
Certification
I understand that the above information will be kept confidential and will only be used for the purposes of
applying to the VIDA or MCSP programs. I certify that the information provided and the statements made are true
to the best of my knowledge.
Date:
Applicant Signature
Date:
Applicant's Parent/Guardian if under 18
IDA Specialist Use Only
Notes:
I have reviewed and verified the applicant's Oregon residency and age. I affirm that this application is complete and all the
following required documents will be included with this application packet:
· Previous year's tax return (if filed)
· Income verification of corresponding income source for all household members
· Oregon residency verification
· Complete application (all fields filled in)
This applicant will be part of our Step 2 Funding Source
Date:
IDA Specialist Signature:
IDA Specialist Name:
*All four pages of this application should be submitted with the application packet.
Page 6 of 6