English CHO Phone Counseling Registration

Pre-Homeownership Education Course Registration Form
Lender Note: The Interview Registration Form should be faxed or emailed to the Center for Homeownership at least two (2) business days before the counseling is expected. Please complete the Expense Analysis Form and the Content Review Form prior to counseling. The process will be delayed if the form is incomplete.

Call:

Center for Homeownership Office Phone # (877) 367-7642 Fax# 336-896-1927
Lender: Please complete (print legibly including all information)
Lender Name*

First NameLast Name
Lender E-mail*
Lender Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Name*

First NameLast Name
Phone *

Area CodePhone Number
Fax

Area CodePhone Number
Loan Type*
Closing Date*
Master Policy Number*
Borrower: Please complete (print legibly including all information)
Borrower Name*

First NameLast Name
Co-Borrower Name

First NameLast Name
Borrower Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Borrower Note: Counseling session requires a 20 – 30 Minute interview by a certified housing and financial counselor with the borrower. Only one borrower must complete the interview. Counselors are available 8:30 am – 5:00 pm eastern standard time. Holidays and weekends are excluded. Check below when available for counseling.
Check all that apply

Spanish Speaking CounselorAssistance for Hearing Impaired
Day

MondayTuesdayWednesdayThursdayFriday
Place

HomeWorkCell
Time

8:30 am-12:00 pm12:00 pm-3:00 pm3:00 pm-5:00 pm
Borrower Authorization: If I fail to make any monthly mortgage payment as agreed, I understand the servicer of my mortgage loan may refer me to a third-party counseling organization or a mortgage insurer, which will advise me about finding ways to meet my mortgage obligation. I hereby authorize the servicer to release certain information related to the servicer’s own experience with me to such third-party counseling organization or mortgage insurer, and request the counseling party contact me. I further hereby authorize the third-party counseling organization of mortgage insurer to make a recommendation about appropriate action to take with regard to my mortgage loan, which may assist the servicer in determining whether to restructure my loan or to offer extraordinary services to preserve my long-term home ownership.
I have read and I agree to the Borrower Authorization*

I AGREE
Borrower Signature
Date
Co-Borrower Signature
Date
Should be Empty:

Pre-Homeownership Education Course Registration Form

Lender: Please complete (print legibly including all information)

Borrower: Please complete (print legibly including all information)