Foreclosure Help Coach Online Application

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Please fill out this Coaching Request Form in order to receive help today from ForeclosureHelpCoach. The form has to be filled out completely in order for us to help you efficiently and give you accurate counseling on how to prevent your foreclosure.

Since 2006, The Helpful Hands Foundation has been a trusted provider of ForeclosureHelpCoach services - providing assistance to homeowners facing the possibility of foreclosure. To make this counseling possible, important personal information must be disclosed. We are obligated to maintain the confidentiality & privacy of your information.

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*Email, First Name & Last Name Fields Are Required!

Home Owner Information
First Name:*
Last Name:*
Property Information
Property Address:
Property City:
Property State:
Property Zip Code:
Contact Information
Home Phone:
Work Phone:
Cell Phone:
Best Time to Call is:
Email (secondary):
Please answer the following questions
1) How many mortgage payments are you behind:
2) How much is your total monthly mortgage payment: $
3) Total monthly net household income: $
4) Total monthly household expenses:
5) Lender name:
6) Loan type:
7) Has the lender begun foreclosure proceedings: Yes No
   If so, When is the trustee sale?
   (mm/dd/yyyy) (If no date please check box )
8) Are you in or have you filed for bankruptcy since owning the home?
    Yes No
   If so, what type of bankruptcy is it:
    Chapter 7
    Chapter 13
   When? (mm/dd/yyyy)
Request Type
I would like to talk to someone about my situtation
I would like to qualify for foreclosure counseling assistance
I would like to qualify for foreclosure prevention coaching
I need information about selling my home before foreclosure
Other (as stated in comments section below)
Please explain the reasons you are behind on your mortgage.
How did you hear about this agency?
Enter Safelock Security Code below to send form:


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