Fuller Center for Housing

Application for Pandemic Mortgage Forbearance Agreement

The current pandemic has caused some financial hardships for many Americans. At this time, (insert official FCH covenant partner name here) will consider making adjustments to homeowner payments on a case by case basis for a specified amount of time during this time of national crisis.

Please answer the following questions if you would like to request a mortgage forbearance agreement or a temporary reduction in your monthly mortgage payment. The Board of Directors will make a decision based on information provided in this application. The Board will inform you of its decision in ______days

Name:_____________________________________________________

Address:________________________________________________________________

Phone Number(s) H:_________________C__________________W________________

1. Are you currently working?_______________

2. If not, what was the date of your last day of work?____________________________

3. Are you eligible for unemployment benefits?___________________

4. Are you receiving unemployment benefits?____________________

Explain your hardship and your need forbearance/adjustment to your mortgage payments:

NOTE: Any payments deferred will be added to the end of your mortgage and MUST BE PAID IN FULL BEFORE ANY TITLE IS RELEASED TO YOU.

Signature__________________________________Date________________________________