Client Expectation Worksheet by wtf69506


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									                   Foreclosure Prevention Counseling Intake Form


Please verify that you have submitted the following items by checking the box:

    Completed the Client Intake Form
    Completed the Family Budget Form
    Completed the Hardship Affidavit
    Signed and Dated the Authorization Form
    Submit Copy of Credit Report to Counselor (free at:
    Signed the Counselor/Client Agreement

Please verify that you have provided one copy of all the documents below:

    Copies of mortgage coupons or billings
    Correspondence from the servicer or attorney
    Copies of pay stubs
    Last year’s tax returns
    Copies of last two months bank statements
    Copies of latest utility bills, credit card statements, car loan statements, student loan
     statements or other consumer debt statements
                                                  Document Tip Sheet

 Document                                      Explanation

                      Outlines the responsibilities of the counselor and the client.
Agreement              Expectation of client honesty
                       Policy for when you are late or don’t attend appointments
                       Outlines expectations about providing necessary documents
                       Sets expectations of required follow-up work or action plan
                       Assurance of confidentiality on the part of the counselor
                       Informs you that there are no certain outcomes
                      Allows counseling agency to:
Release of Info and   • Receive information from other sources about your loan
Authorization Form
                      • Submit data about your case into a data collection system
                      • Share information with the mortgage company
                      • Share non-identifying information with funders
                      Gathers the necessary information to assist in foreclosure
Intake Application
                      intervention including:
                       • Homeowner contact information
                       • Homeowner contact with the servicer
                       • Mortgage information
                       • Insurance taxes and home owner association dues information
                       • Property information
                      Provides necessary information to the counseling agency to
Income and
Expenses              help you develop the best foreclosure intervention plan for
Worksheet             you.
                       • This Worksheet must be completed in full. If there is
                          incomplete information, your appointment will be postponed
                          until the information is complete
                      Describes your hardship to the mortgage company. Includes:
Hardship Affidavit
                      •   Matter of fact description of what caused your default
                      •   Overview of your financial situation
                      •   Actions you have taken
                      Be certain to avoid blaming others for the default. Be short
                      and to the point. Keep in mind this is a business decision for
                      your mortgage company.
                  Neighbor to Neighbor Client/Counselor Agreement

Neighbor to Neighbor and its counselors agree to provide the following services:

Development of a spending plan
Analysis of the mortgage default, including the amount and cause of default
Presentation and explanation of reasonable options available to the homeowner
Assistance communicating with the mortgage servicer and other creditors
Timely completion of promised action
Explanation of collection and foreclosure process
Identification of assistance resources
Referrals to needed resources
Confidentiality, honesty, respect and professionalism in all services

I/We,                                               agree to the following terms of

I/We will always provide honest and complete information to my/our counselor, whether
verbally or in writing.
I/We will provide all necessary documentation and follow-up information within the
timeframe requested.
I/We will be on time for appointments and understand that if we are late for an
appointment, the appointment will still end at the scheduled time.
I/We will call within 4 hours of a scheduled appointment if I/we will be unable to attend
an appointment.
I/We will contact the counselor about any changes in our situation immediately.
I/We understand that breaking this agreement may cause the counseling organization to
sever its service assistance to me/us.

Homeowner                                                  Date

Homeowner                                                  Date

Counselor                                                  Date
I realize that in order for my housing counselor to understand my situation, a variety of
information, such as: financial, employment, credit history, family, and loan information may be
needed. I, therefore, authorize my housing counselor to obtain the necessary information and
enter it into the database. I also authorize my lender and/or realtor to provide pertinent
information to my Neighbor to Neighbor housing counselor. I further authorize my housing
counselor to disclose any pertinent information to relevant parties; i.e. lenders, HUD, real estate
agent, etc., if s/he feels that such disclosure will help improve my housing situation. I further
understand that, other than disclosures intended to help improve my housing situation, all
personal information I provide Neighbor to Neighbor will be kept confidential.


I understand that buying a home and receiving a mortgage loan are legal transactions, and that
foreclosure is a legal proceeding. If I want to receive legal advice and/or representation in these
matters, I should hire an attorney. I agree Neighbor to Neighbor, its employees, agents, and
directors are not liable for any claims and causes of action arising from errors or omissions.

I authorize Neighbor to Neighbor, Inc. to contact our/my attorney, mortgage company, realtor,
human service agency, public trustee, and any other company or agency to release or to
request information they need to assist in counseling us/me regarding our/my mortgage or
home purchase. I understand that this is for the purpose of evaluating our/my request for
services and to identify other possible resources for service. All information released or
required will be treated as confidential. I understand that Neighbor to Neighbor resources,
including affordable housing, may be available to me, but I am under no obligation to utilize
these services.
I also hereby state and affirm that the information I have provided to Neighbor to Neighbor, Inc.,
its staff or representatives, is true and correct to the best of my knowledge. I acknowledge that
any misinformation that I knowingly provide may result in my request for housing and/or
financial assistance being denied presently and in the future. I understand that Neighbor to
Neighbor resources including affordable housing may be available to me, but I am under no
obligation to utilize these services or the services of any of our partners.

Client’s Signature _____________________________________                                 Date ____________

Client’s Signature _____________________________________                                 Date ____________

   This information is requested by Neighbor to Neighbor in order to assure the Federal government, acting through
   federal, state, and local agencies, that this agency is in compliance with Federal laws prohibiting discrimination
   against applicants on the basis of race, national origin and sex, are complied with. You are not required to furnish
   this information, but encouraged to do so. This information will not be used in evaluating your application or to
   discriminate against you in any way. However, if you choose not to furnish it, the counselor is required to not the
   race/national origin and sex of individual applicants on the basis of visual observation or surname.
                                                                             fort collins office           loveland office
                                                                             1550 blue spruce dr           565 n cleveland ave
                                                                             fort collins, co 80524        loveland, co 80537
                                                                             P: 970 488 2365               P:970 663 4163
                                                                             F: 970 488 2355               F:970 663 2860

                                        Intake Application (page 1)

All of the information that I/We provided in this worksheet is correct and factual. No information has been withheld.
We understand the necessity for accurate and complete information and we will provide any needed information to
complete this worksheet. We understand that deliberately providing inaccurate information or an unwillingness to
timely provide the counselor with the necessary information or documents to assist us will result in a closing of our

Homeowner (A) Signature                                                  Date

Homeowner (B) Signature                                                  Date

                                             HOMEOWNER INFORMATION

         Information                             Homeowner A                                    Homeowner B


    Birth date

    Social Security Number

    Property Address

    Email Address

     Phone Number


   How did you hear                                                                                     Have you had
   about N2N?                                                                                           previous workouts?
                                                                                                         Yes       No

   What caused your
   situation?                                                                                           Bankruptcy? Y / N

                                                                                                        Type? 7 / 13

   What steps have                                                                                      Discharged? Y / N
   you already taken?
                                           Intake Application (Page 2)
                                        Mortgage and Property Information

            First Mortgage                                Second Mortgage                               Third Mortgage

Payment $_____________                        Payment      $_____________                 Payment       $_____________
Do you pay taxes and insurance with
your payment?       Yes  No                 Mortgage Company:                           Mortgage Company:
Do you pay your association fees with
                                              _____________________________               _____________________________
your payment?      Yes  No
                                              Interest Rate?   ________                   Interest Rate? ________
Mortgage Company:
                                                                 Fixed  ARM                              Fixed        ARM
____________________________                  Delinquent?         Yes       No          Delinquent?           Yes      No
Loan #:

____________________________                  Months Delinquent: _____________            Months Delinquent: _____________
Interest Rate? ________
                Fixed  ARM
                                              Amount Delinquent: $_____________           Amount Delinquent: $_____________
Delinquent?        Yes       No
Months Delinquent: _____________
Amount Delinquent: $_____________

Delinquent on HOA payments?            Yes       No      Monthly Amt : $____________         Amount Delinquent $_____________

Delinquent on Taxes?                   Yes       No       Annual Taxes: $____________        Amount Delinquent $_____________

Mortgage Insurance?                    Yes       No       Mortgage Insurance Company ___________________________________

Has home been refinanced?              Yes       No               How many times?       1       2     3        4 or more

Date of last refinance              ______________________________

Type of Property  Single Family          2- 4 Unit      Townhouse  Condo        Cooperative  Mobile Home          Other

Property Condition                             Year Purchased:     ____________       Purchase Price: $______________

         Excellent       Good                Estimated Value? $___________

                                               Source:             ____________________________________________
         Fair            Poor
                                               Listed?              Yes  No         List Price $___________________

                                               Time on Market?      0-3 months         3-6 months

                                                                    6-12 months        More than one year
                                           Income and Expense Worksheet
                                 Homeowner A         Full         Homeowner B
    Income Source                  Amount           Time?           Amount       Full Time?   Income Totals
Employment 1

Employment 2

Employment 3

Social Security



Child/Spousal Support

Other Income Source

Totals                                                                                                         Total
                                                                                                Willing to
               Expenses                          Monthly Amount          Amount Delinquent    Reduce? Y/N

Mortgage Payment

Second Mortgage

Credit Card Payment Totals

 Student Loan Totals

 Car Payment Totals

 Auto & Medical Insurance

 Utilities Totals (Electric/ Gas/ Water)

 Child Care/ Child Support


 Transportation (Gas / Tolls)


 Phone & Cable


 Personal (hair, clothes, entertainment)

 Total Costs
                                           Demographics Worksheet

This information is used by the funders of the program who make this free service available. It also helps eliminate
discrimination. It will only be used in aggregate form and will not be used in such a way to publicly identify you.
Providing this information is optional.

Race & Ethnicity Information

                        Single Race:                                      Multi Race:
                          American Indian / Alaskan Native                 American Indian / Alaskan Native/White
     Male                Asian
     Female                                                                American Indian / Alaskan Native/Black
                          Black or African American                        Asian and White
                          Native Hawaiian or Pacific Islander              Black or African American/White
    Ethnicity             White                                            Native Hawaiian or Pacific Islander/Black
     Hispanic            Undisclosed                                      Other Mixed Race __________________
     Non-Hispanic

  Household Information

                                                     Household Gross Annual               Veteran
    Head of Household                                Income:                              Disabled: _____________
     Single
     Female-headed single parent                      Children & Ages:
     Male-headed single parent
                                                     Name _____________________________ Age ________
     Married without dependents
     Married with dependents                        Name _____________________________ Age ________
     2 or more unrelated adults
                                                     Name _____________________________ Age ________
     Other
                                                     Name _____________________________ Age ________
                                       Sample Hardship Letter

Date:   Some month, one day, this year

Re:                       Hardship Explanation
Borrowers:                Annette and Ronald Moore
Loan Number:              684592729333
Property Address:         145 Glee Club Lane, Happyville, USA

We purchased our home five years ago and had never been late on our payments
until the last four months. Ronald lost his job six months ago but has recently been
hired by another firm at a similar wage. Annette has a health issue that prevents her
from working at this time.

We are accustomed to paying our bills and it has been tough for us to accept that we
were unable to meet our obligations. However, things have stabilized for us. We
have been working with a local non-profit counselor to review our financial situation.
We have reduced our expenses and made other adjustments. This lets us to be in a
situation to return to making our payments, although we do not have the money to
pay our overdue payments.

Our loan is a fixed rate loan and while the value on our property has decreased in
the last two years, it is still above our loan amount. Given the significant drop in
income the last six months we have been unable to save any money to put toward
our delinquency. We are asking only for a modification that would allow us to add
our delinquent payments to our loan balance so that we can begin to make our
mortgage payments again.

Thank you in advance for your time and consideration in this matter.

Ronald Moore
Annette Moore
             Hardship Affidavit

Do not expand and use this form as the information
with Making Home Affordable changes frequently.
Go to the link below to access the hardship Affidavit.

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