| Counseling Registration Form |
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| All Fields Below Are Required |
| Counseling Session: | Mortgage Default |
| Counseling Language: | |
| Late on Mortgage: | |
| Have you previously contacted the Hope Hotline or any other counseling? | |
| First Name: | |
| Last Name: | |
| Address: | |
| City: | |
| State: | Florida |
| Zip: | |
| County You Currently Live: | |
| Phone: | |
| Best to Call You: | |
| Email Address: | |
| Confirm Email Address: | |
| Race: | |
| Age: | |
| Marital: | |
| Family Size: | |
| Household Income: | |
| Sex: | |
| Ethnicity: | |
| Referred by: (Type if applies - This information is optional) |
| Church Name: | |
| Lender: | |
| Builder: | |
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Warning:
This type of counseling may not be available and is currently 3-15 backlogged due to the number of requests for this service.
You will receive a call from a HANDS Counselor to schedule your appointment, within 2 weeks of
your registration for counseling.
If you need immediate assistance and have been served a summons (which must be answered within 20 days)
please immediately call 1-888-995 HOPE (4673).
If you are no longer in need of our counseling services when our Counselor calls, just let us know -
otherwise we will set you the next available appointment.
Your HANDS Counselor will give you a reminder call the day prior to your
Counseling session and review with you the information to bring for counseling.
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