Please enable JavaScript in your browser to complete this form.Have you received notice of a foreclosure sale date?YesNoIf yes, what is the sale date?Enter date of foreclosure saleHave you worked (past or present) with another agency for this issue?YesNoIf yes, what is the name of the agency you worked with?When did you close on your home (date of Deed of Trust?)What kind of loan do you have?FHAVAConventionalFannie MacUSDAFreddie MacPrivate by IndividualOtherWhen was your last on-time mortgage payment?MM/DD/YYYYYAre you currently behind on your mortgage payments?YesNoApplicant Name *FirstMiddleLastCo-Applicant Name *FirstMiddleLastLOAN SERVICERLoan Servicer (to whom you make your payments)Name of company Name of Agent (if known)Email of agent (if known)Company Phone NumberCompany Fax NumberAPPLICANT INFORMATIONName *FirstMiddleLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSocial Security NumberBirthdateHome Phone NumberCell Phone Number Work Phone Number EmailGenderRaceAmerican Indian/Alaskan NativeBlack/African AmericanAmerican Indian/Alaskan Native & Black/African AmericanBlack/African American & WhiteAmerican Indian/Alaskan Native & WhiteNative Hawaiian/Other Pacific IslanderAsianWhiteAsian & WhiteOther multiple raceEthnicityHispanic or LatinoNot Hispanic or LatinoChoose oneEducation LevelElementary SchoolJunior College/Associates DegreeTech/Vocational SchoolJunior High SchoolBachelor DegreeOtherHigh School / GEDGraduate DegreeNoneMarital StatusSingleMarriedLegally SeparatedIf married, date of marriageIf legally separated, do you have a legal separation agreement filed with the courts?YesNoEmploymentName of Primary EmployerAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number of EmployerHire DateTitle/PositionYearly Gross Income (before taxes)Full Time or Part TimeFull TimePart TimeChoose onePay FrequencyWeeklyEvery Two WeeksTwice a monthMonthlyCo-Applicant InformationName *FirstMiddleLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSocial Security NumberBirth dateHome Phone NumberCell Phone NumberWork Phone NumberEmailGender Race American Indian/Alaskan NativeBlack/African AmericanAmerican Indian/Alaskan Native & Black/African AmericanBlack/African American & WhiteAmerican Indian/Alaskan Native & WhiteNative Hawaiian/Other Pacific IslanderAsianWhiteAsian & WhiteOther multiple raceEthnicity Hispanic or LatinoNot Hispanic or LatinoChoose oneEducation Level Elementary SchoolJunior College/Associates DegreeTech/Vocational SchoolJunior High SchoolBachelor DegreeOtherHigh School / GEDGraduate DegreeNoneMarital Status (copy)SingleMarriedLegally SeparatedIf married, date of marriage If legally separated, do you have a legal separation agreement filed with the courts? YesNoEmployment Name of Primary Employer AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number of Employer Hire Date Title/Position Yearly Gross Income (before taxes) Pay Frequency (copy)WeeklyEvery Two WeeksTwice a monthMonthlyHOUSEHOLD INFORMATIONTotal Household Size (include yourself in this number)Total yearly income for all household members (before taxes)Is there anyone else on the loan who is not living in the home? YesNoIs there anyone else on the tile (the Deed of Trust) who is not living in the home? YesNoWho lives in the home with you? (write down everyone, including yourself)Name *FirstLastRelationshipAgeName FirstLastRelationship Age Name FirstLastRelationship Age Name FirstLastRelationship Age Name FirstLastRelationship Age Name FirstLastRelationship Age OTHER HOUSEHOLD INCOME-MONTHLY INCOME BEFORE TAXESType of IncomeTotal All JobsApplicant$Co-Applicant$Alimony/Child Support$$Disability$$Self-Employment Income$$Dependent SSI Income$$Retirement/Pension Income$$Unemployment $ SPublic Assistance $ $Other income $ $If you receive child support payments, how long will support last?Is the child support court ordered?YesNoSAVINGS/INVESTMENTSPlease list approximate balances of all accounts you may have (multiple checking accounts, savings accounts, etc.) Checking AccountApplicant $Co-Applicant $ Savings Account$$ Cash$$ Other (stocks retirement, etc.)$$Are you expecting to receive additional funds? (i.e. tax redufnds, settlemts, gift funds, property sales, inheritance etc.)YesNoIf yes, what is the amount of these funds?$What is the source of these funds? PROPERTY INFORMATIONWhat was the purchase price of your home?The property is Primary residenceInvestment propertyOtherType of PropertySingle family homeCondo2+ unitTownhomeMobile HomeOtherMortgage InformationLoan numberCurrent loan balanceCurrent interest rateMy interest rate is FixedAdjustableOtherDoes your monthly mortgage payment include homeowners insurance?YesNoDoes your monthly mortgage payment include property taxes?YesNoHave you ever refinanced your mortgage? YesNoIf yes, how many times?When was the last time?ADDITIONAL QUESTIONSDo you wish to stay in your home?YesNoHow did you hear about us?What caused your current situation?What steps (if any) have you taken to improve your financial situation?Is there anything we should now that is NOT mentioned in this intake packet (current or future living situation, loan status, household income, household members, etc.)?Applicant - Are you CURRENTLY in Chapter 13 Bankruptcy?YesNoCo-Applicant - Are you CURRENTLY in Chapter 13 Bankruptcy?YesNoIf yes, when did it begin?If yes, when did it begin? When will it be discharged?When will it be discharged? How much is the payment?How much is the payment? Applicant - Have you HAD a Chapter 13 Bankruptcy in the past 10 years?YesNoCo-Applicant - Have you HAD a Chapter 13 Bankruptcy in the past 10 years? YesNoIf yes, when was it discharged?If yes, when was it discharged?Applicant - Have you HAD a Chapter 7 Bankruptcy in the past 10 years? YesNoCo-Applicant - Have you HAD a Chapter 7 Bankruptcy in the past 10 years? YesNoIf yes, when was it discharged? If yes, when was it discharged? Applicant- Have you legally changed your name since you last purchased or refinanced your home?YesNoCo-Applicant- Have you legally changed your name since you last purchased or refinanced your home?YesNoApplicant- Do you currently receive a Section 8 Housing Choice Voucher?YesNoCo-Applicant- Do you currently receive a Section 8 Housing Choice Voucher?YesNoIf yes, how much per month?$If yes, how much per month?$Applicant- Are you a veteran?YesNoCo-Applicant- Are you a veteran?YesNoApplicant- Are you disabled?YesNoCo-Applicant- Are you disabled?YesNoApplicant- Were you born in the United States of America?YesNoCo-Applicant- Were you born in the United States of America?YesNoApplicant- if no, are you a permanent resident or DACA recipient?YesNoCo-Applicant- if no, are you a permanent resident or DACA recipient?YesNoADDITIONAL EMPLOYMENTAdditional employment of:ApplicantCo - ApplicantPlease choose oneName of EmployerAddress of EmployerAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone number of employer?Hire DateYour Job Title / PositionYearly Gross Income (before taxes)$Is this a full time job or a part time job?Full TimePart Timechoose oneWhat is your pay frequency?WeeklyEvery Two WeeksTwice a monthMonthlyAdditional employment of: (copy)ApplicantCo - ApplicantPlease choose oneName of Employer (copy)Address of Employer (copy) (copy)Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone number of employer? (copy)Hire Date (copy)Your Job Title / Position (copy)Yearly Gross Income (before taxes) (copy)$Is this a full time job or a part time job? (copy)Full TimePart Timechoose oneWhat is your pay frequency? (copy)WeeklyEvery Two WeeksTwice a monthMonthlyAdditional employment of: (copy) (copy)ApplicantCo - ApplicantPlease choose oneName of Employer (copy) (copy)Address of Employer (copy)Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone number of employer? (copy) (copy)Hire Date (copy) (copy)Your Job Title / Position (copy) (copy)Yearly Gross Income (before taxes) (copy) (copy)$Is this a full time job or a part time job? (copy) (copy)Full TimePart Timechoose oneWhat is your pay frequency? (copy) (copy)WeeklyEvery Two WeeksTwice a monthMonthlyINTAKE FORM VERIFICATION - APPLICANTBy signing below, I acknowledge the following terms: · I understand that this form will be used in conjunction with other documents and information in order to determine my eligibility for down payment/closing cost assistance. · I agree that this form has been filled out truthfully and accurately to the best of my knowledge and ability. If anything on this form should change, I agree to contact The Housing Partnership, Inc. (THP) as soon as possible to correct the information. · I acknowledge that if pertinent details change on this form and I do not notify THP in a timely manner, it may risk my eligibility for down payment/closing cost assistance. Clear Signature Applicant signature and dateINTAKE FORM VERIFICATION - CO-APPLICANT By signing below, I acknowledge the following terms: · I understand that this form will be used in conjunction with other documents and information in order to determine my eligibility for down payment/closing cost assistance. · I agree that this form has been filled out truthfully and accurately to the best of my knowledge and ability. If anything on this form should change, I agree to contact The Housing Partnership, Inc. (THP) as soon as possible to correct the information. · I acknowledge that if pertinent details change on this form and I do not notify THP in a timely manner, it may risk my eligibility for down payment/closing cost assistance. Clear Signature Co-Applicant signature and dateCREDIT AUTHORIZATION - APPLICANTBy signing below, I acknowledge the following terms: · I authorize The Housing Partnership, Inc. (THP) to obtain my credit report(s) from my lender and review said credit report(s) for housing counseling, in connection with my pursuit of a loan to purchase real property. · If THP is unable to obtain said credit report(s), I authorize them to pull my credit report(s). · I understand that if THP needs to pull my credit report(s), there will be a fee of $17.98 for individual applicants or $35.96 for two applicants that I must pay per direction by THP. · I understand that this credit pull from THP would be a soft inquiry and would not impact my scores or report(s). Clear Signature Applicant signature and dateCREDIT AUTHORIZATION - CO-APPLICANT By signing below, I acknowledge the following terms: · I authorize The Housing Partnership, Inc. (THP) to obtain my credit report(s) from my lender and review said credit report(s) for housing counseling, in connection with my pursuit of a loan to purchase real property. · If THP is unable to obtain said credit report(s), I authorize them to pull my credit report(s). · I understand that if THP needs to pull my credit report(s), there will be a fee of $17.98 for individual applicants or $35.96 for two applicants that I must pay per direction by THP. · I understand that this credit pull from THP would be a soft inquiry and would not impact my scores or report(s). Clear Signature Co-Applicant signature and dateCLIENT/COUNSELOR AGREEMENTClient/Counselor Agreement The Housing Partnership, Inc. (THP) and its counselors agree to provide the following services: 1. Analysis of any mortgage default, including the amount and cause of the default 2. Explanation of default and/or foreclosure process 3. Discussion of reasonable options available to the homeowner 4. Assistance communicating with the mortgage loan servicer and other creditors 5. Development an action plan and tracking of timely completion of promised action 6. Identification of assistance resources 7. Referrals to needed resources 8. Confidentiality, honesty, respect, and professionalism in all services. I agree to the following terms of service: 1. I will provide honest and complete information to my counselor(s), whether verbally or in writing 2. I will provide all necessary documentation and follow-up information in the form and timeframe requested 3. I will be on time for appointments and understand that if I am late for an appointment, the appointment will still end at the scheduled time or will be rescheduled 4. I will give the counselor(s) appropriate notice if I am unable to attend an appointment 5. I will complete the action plans as agreed upon (and modified as deemed appropriate) to the best of my ability 6. I will contact the counselor(s) about any changes in my situation immediately 7. I understand that breaking this agreement may cause THP to cease to provide its services to me. Clear Signature Applicant signature and dateClient/Counselor Agreement The Housing Partnership, Inc. (THP) and its counselors agree to provide the following services: 1. Analysis of any mortgage default, including the amount and cause of the default 2. Explanation of default and/or foreclosure process 3. Discussion of reasonable options available to the homeowner 4. Assistance communicating with the mortgage loan servicer and other creditors 5. Development an action plan and tracking of timely completion of promised action 6. Identification of assistance resources 7. Referrals to needed resources 8. Confidentiality, honesty, respect, and professionalism in all services I agree to the following terms of service: 1. I will provide honest and complete information to my counselor(s), whether verbally or in writing 2. I will provide all necessary documentation and follow-up information in the form and timeframe requested 3. I will be on time for appointments and understand that if I am late for an appointment, the appointment will still end at the scheduled time or will be rescheduled 4. I will give the counselor(s) appropriate notice if I am unable to attend an appointment 5. I will complete the action plans as agreed upon (and modified as deemed appropriate) to the best of my ability 6. I will contact the counselor(s) about any changes in my situation immediately 7. I understand that breaking this agreement may cause THP to cease to provide its services to me. Clear Signature Co-Applicant signature and dateCONFLICT OF INTERESTThe Housing Partnership, Inc. (THP) is a nonprofit organization that is in business to provide home repair services, homebuyers and renters training and counseling (credit and budget), affordable housing development including both for-rent and for-sale properties, and mortgage assistance. As a provider of multiple services there is a possibility of conflict of interest for the prospective clients, particularly those seeking training and counseling services. Since you are or will be receiving training and counseling designed for homebuyers, homeowners, or renters, THP staff want to be clear that you understand that you: 1. Are under no obligation to obtain a loan or grant for home repair, down payment and closing cost assistance, or home purchase from THP or any individual or company they may refer you to; and 2. Are under no obligation to utilize the services of any person or company they may refer you to for real estate, inspection, construction, home repairs, loans and other services or forms of assistance. Personal information provided to us as part of the services will not be shared with another party without your expressed written consent. Clear Signature Applicant signature and dateThe Housing Partnership, Inc. (THP) is a nonprofit organization that is in business to provide home repair services, homebuyers and renters training and counseling (credit and budget), affordable housing development including both for-rent and for-sale properties, and mortgage assistance. As a provider of multiple services there is a possibility of conflict of interest for the prospective clients, particularly those seeking training and counseling services. Since you are or will be receiving training and counseling designed for homebuyers, homeowners, or renters, THP staff want to be clear that you understand that you: 1. Are under no obligation to obtain a loan or grant for home repair, down payment and closing cost assistance, or home purchase from THP or any individual or company they may refer you to; and 2. Are under no obligation to utilize the services of any person or company they may refer you to for real estate, inspection, construction, home repairs, loans and other services or forms of assistance. Personal information provided to us as part of the services will not be shared with another party without your expressed written consent. Clear Signature Co-Applicant signature and datePRIVACY POLICY AND PRACTICESWe at The Housing Partnership, Inc. (THP) value your trust and are committed to the responsible management, use, and protection of personal information. This notice describes our policy regarding the collection and disclosure of personal information. Personal information, as used in this notice, means information that identifies an individual personally and is not otherwise publicly available information. Information We Collect We collect personal information to support our housing counseling program and to aid you in qualifying for special funding for potential mortgage assistance. We may collect personal information about you from the · Applications or other forms that we receive from you; Correspondence about your transactions with us, our affiliates, or others; Credit reports from a consumer reporting agency; and · Personal and employment references Information We Disclose We may disclose the following kinds of personal information about you: · Information we receive from you 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, our affiliates, or others, such as your account balance, payment history, and parties to your transactions; and · Information we receive from a consumer reporting agency, such as your credit reports, credit history, and creditworthiness To Whom Do We Disclose We may disclose personal information about you to third parties as permitted by law. These third parties may include government and nonprofit organizations involved in community development, where your personal information would only be shared for program review, auditing, research, and oversight purposes. These third parties may also include other entities that may be involved in the efforts to assist with loan modification, foreclosure intervention, or other post-purchase services. By signing below, you acknowledge and accept the collection and disclosure of personal information as described in this form. Clear Signature Applicant signature and dateWe at The Housing Partnership, Inc. (THP) value your trust and are committed to the responsible management, use, and protection of personal information. This notice describes our policy regarding the collection and disclosure of personal information. Personal information, as used in this notice, means information that identifies an individual personally and is not otherwise publicly available information. Information We Collect We collect personal information to support our housing counseling program and to aid you in qualifying for special funding for potential mortgage assistance. We may collect personal information about you from the · Applications or other forms that we receive from you; · Correspondence about your transactions with us, our affiliates, or others; · Credit reports from a consumer reporting agency; and · Personal and employment references Information We Disclose We may disclose the following kinds of personal information about you: · Information we receive from you 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, our affiliates, or others, such as your account balance, payment history, and parties to your transactions; and · Information we receive from a consumer reporting agency, such as your credit reports, credit history, and creditworthiness To Whom Do We Disclose We may disclose personal information about you to third parties as permitted by law. These third parties may include government and nonprofit organizations involved in community development, where your personal information would only be shared for program review, auditing, research, and oversight purposes. These third parties may also include other entities that may be involved in the efforts to assist with loan modification, foreclosure intervention, or other post-purchase services. By signing below, you acknowledge and accept the collection and disclosure of personal information as described in this form. Clear Signature Co-Applicant signature and dateTHIRD PARTY AUTHORIZATIONI authorize The Housing Partnership, Inc. to: Request and/or release any documentation that I have provided to any third party that is directly involved in this transaction and is necessary to assist me with mortgage payment assistance, loan modification, foreclosure intervention, or other post-purchase services. Clear Signature Applicant signature and dateI authorize The Housing Partnership, Inc. to: Request and/or release any documentation that I have provided to any third party that is directly involved in this transaction and is necessary to assist me with mortgage payment assistance, loan modification, foreclosure intervention, or other post-purchase services. Clear Signature Co-Applicant signature and dateAUTHORIZATION TO RELEASE INFORMATIONApplicant Name *FirstMiddleLastProperty AddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFirst Loan NumberSecond Loan NumberApplicant Social Security NumberI understand that my mortgage servicer and/or HUD may refer me to an independent counseling organization to help me with my financial obligations. For this purpose, I hereby authorize the servicer to release certain financial information, related to my mortgage loan, to The Housing Partnership, Inc. (THP), P.O. Box 16356, 729 Lemay Ferry Rd, St. Louis, MO 63125. All information released to THP will remain strictly confidential. This information will include but is not limited to: Original Loan Amount Current Balance Amount Past Due/Date of Last Payment Payment History Monthly Payment Amount Loss Mitigation/Modification Agreement Escrow statement Payment Due Date I further hereby authorize THP to furnish any information regarding my financial status which may assist the servicer or its affiliates in determining whether my homeownership may be preserved by restructuring my loan or by other services. I also authorize THP to receive copies of documents pertaining to my financial information including but not limited to: Forbearance Agreement, Modification, Partial Claim, Reinstatement Figures, and Payoff Statements. I may be referred to other housing services of THP or another agency or agencies, as appropriate, that may be able to assist me with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. Clear Signature Applicant signature and dateCo-Applicant Name FirstMiddleLastProperty AddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFirst Loan Number Second Loan Number Co-Applicant Social Security Number I understand that my mortgage servicer and/or HUD may refer me to an independent counseling organization to help me with my financial obligations. For this purpose, I hereby authorize the servicer to release certain financial information, related to my mortgage loan, to The Housing Partnership, Inc. (THP), P.O. Box 16356, 729 Lemay Ferry Rd, St. Louis, MO 63125. All information released to THP will remain strictly confidential. This information will include but is not limited to: Original Loan Amount Current Balance Amount Past Due/Date of Last Payment Payment History Monthly Payment Amount Loss Mitigation/Modification Agreement Escrow statement Payment Due Date I further hereby authorize THP to furnish any information regarding my financial status which may assist the servicer or its affiliates in determining whether my homeownership may be preserved by restructuring my loan or by other services. I also authorize THP to receive copies of documents pertaining to my financial information including but not limited to: Forbearance Agreement, Modification, Partial Claim, Reinstatement Figures, and Payoff Statements. I may be referred to other housing services of THP or another agency or agencies, as appropriate, that may be able to assist me with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. Clear Signature Co-Applicant signature and dateComment or MessageSubmit