Iowa Mortgage Help

"After I was laid off from my job and I had my first child, I knew I was in a bad position. When my lender started foreclosure proceedings, Iowa Mortgage Help got involved. The process was very smooth and my rep stayed in contact with me, and even afterward called to make sure everything was going okay."

-- Zakiya Jenkins

"I don't know what I would have done without the help of Iowa Mortgage Help. After a long and expensive battle with medical bills, I faced foreclosure of a home that has been in my family for over 100 years. I was finally able to get a successful loan modification and a payment I can afford in order to take care of my home. I'd have lost everything if it wasn't for their assistance."

-- Rebecca Swyers

APPLICATION

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Congratulations! You are taking the first step toward getting the help you need to solve your financial challenges. The Iowa Mortgage Help program has assisted more than 35,000 homeowners with free, confidential counseling and the program now offers even more tools for homeowners through the recently announced mortgage settlement with major lenders.

You may either contact the Iowa Mortgage Help hotline at 877-622-4866, or you may fill out and submit the form provided below. The Iowa Mortgage Help team is available to walk you through the process or to provide you the next steps of the Iowa Mortgage Help and/or the mortgage settlement process, depending on your situation.

Initial Information

How did you hear about this hotline (check all that apply):

	Mortgage Mediation Notice from Lender/Servicer's Attorney
	A friend/family member told me
	Saw a news story on television
	Google search
	Coverage of Mortgage Settlement Agreement
	Saw an advertisement on television
	Saw a news story in the newspaper
	Saw an advertisement in the newspaper
	Saw a news story on a web site
	Saw a billboard
	Saw theatre advertisement
	Saw a flier/poster
	Listened to an advertisement on the radio
	Listened to a news story on the radio
	Received a letter from the Governor or Attorney General
	Received a postcard
	HOPE Hotline referral
	Lender - Emergency Foreclosure Assistance Fund (EFAF)
	Lender - Eviction Foreclosure Prevention Program
	Local Emergency Management Agency
	Other

Current Lender/Servicer: Lenders in red are Settlement Lenders

Lender Name:

Has a Sheriff's Sale occurred or have you been legally evicted from your home?

Applicant

First Name:

Last Name:

Last 4 Digits of SSN:

Race:

Ethnicity:

Gender:

Birth Date:

Co-Applicant (if applicable)

First Name:

Last Name:

Last 4 Digits of SSN:

Race:

Ethnicity:

Gender:

Birth Date:

Home Address (required)

Street Number:

Street Name:

Unit:

P.O. Box:

City:

State:

Postal Code:

Is this address owner occupied/primary residence?

Mailing Address (if different from property)

Current Address

Address 1:

Address 2:

City:

State:

Postal Code:

Household Type

Household Type:

If Other, please specify:

Contact Information (please provide at least one phone number)

E-mail:

Home Phone: Example: 515-555-5555

Office Phone:

Mobile Phone:

Co-Applicant's Office

Co-Applicant's Mobile:

Opt in to allow text messaging?

Best Phone to Reach You At:

Best time to contact (check all that apply):

	Morning (8:00 - 10:00 am)
	Late Morning (10:00 - 12:00 noon)
	Noon (12:00 noon - 2:00 pm)
	Early Afternoon (2:00 - 4:00 pm)
	Late Afternoon (2:00 - 6:00 pm)
	Evening (6:00 - 8:00 pm)

Do you have access to a computer with internet access?

Do you have access to a printer?

Additional Information

Please provide us with any other information which might be helpful:

Authorization to Proceed

At this time would you like assistance from an IMH counselor?

I agree that by answering “Yes” to this statement, I am giving the Iowa Mortgage Help initiative my consent to release all of the information provided in my application to my lender and, if indicated, to a counseling agency that will assist me through the counseling process:

PARTNERS: Office of the Attorney General | Iowa Finance Authority | Iowa Legal Aid | Strategic America

	Relocation due to loss of job
	Home damaged - Natural Disaster
	Home damaged – fire
	Home declared uninhabitable (Health/Safety)
	Other

Select Primary	Check All that Apply
		Reduction in income
		Poor budget management skills
		Loss of income
		Medical issues
		Increase in expense
		Divorce/separation
		Death of family member
		Business venture failed
		Increase in loan payment
		Other