Indiana Foreclosure Prevention Network Housing Counselor Request
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
Phone Number
Please enter a valid phone number.
Email
example@example.com
How many months are you behind on your mortgage? Select one
Please Select
0-3 Months
3-6 Months
6-9 Months
more than 9 months
Do you have a sheriff sale?
Yes
No
If Yes, what is the sale date?
-
Month
-
Day
Year
Date
Are you in active bankruptcy?
Yes
No
Have you received mortgage assistance in the past?
Yes
No
If Yes, select the program(s).
Please Select
Hardest Hit Fund (HHF)
Indiana Homeowner Assistance Fund (IHAF)
Both
Submit
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