Center for New York City Neighborhoods Escalations Request
Counselor Information
Organization
Counselor First Name
Counselor Last Name
Counselor Email
Counselor Phone
Escalation Issue
Please select...
2MP Request
An application has been wrongfully denied/Denials (includes re-entry issues)
BIB held insurance funds
Delay in review/processing modification documents/providing reinstatement letter
Junior lien and/or title issues
Payment Issues (Escrow account, Tax and/or Insurance)
Permanent Modification Issues (not honoring mod, delay in conversion, recording issues, etc)
Second / junior lien issues and/or title issues
Servicer transfer issues
Short sale/ Deed in lieu Issues
The servicer is providing inconsistent offers and/or retracting offers
Other Escalation Issue /
Please explain loss mitigation attempts to date, your request and why client is qualified in 160 words or less
Type of Loss Mitigation Requested
Please select...
Loan modification
Flex-Mod
FHA-Modification
Partial Claim
Short Payoff
Repayment Plan
Loan Forgiveness
Forbearance
Reinstatement
Refinance
FHA-Refinance
Short-Sale
MAP reinstatement
Partial Reinstatement/ Loan modification with MAP
Escrow issues Resolved
Fees waived
Property Address
Street Address (Including Unit #, if applicable)
City
State
Please select...
NY
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP Code
County
Primary Borrower Information
First Name
Last Name
Home Phone
Mobile Phone
Preferred Phone
Please select...
Home
Mobile
Email
Last 6 Digits of Social Security #
Gross Monthly Income Information
Wages
Rental Income
Contribution from Household Member
Non-Taxable Social Security/SSDI
Other Income
Is there a co-borrower?
Please select...
Yes
No
Co-borrower Information
First Name
Last Name
Home Phone
Mobile Phone
Preferred Phone
Please select...
Home
Mobile
Email
Last 6 Digits of Social Security #
Gross Monthly Income Informatiomn
Wages
Rental Income
Contribution from Household Member
Non-Taxable Social Security/SSDI
Other Income
Primary Mortgage
Mortgage lender name
Mortgage servicer name
Loan #
Current Interest Rate
Monthly Principal and Interest
Mortgage maturity date
Original mortgage balance
Unpaid Principal Balance
Total Amount of Arrears
Number of Months in Arrears
GSE Loan Type?
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Fannie Mae
Freddie Mac
FHA
VA
FHA #
Do you have a second mortgage?
Please select...
Yes
No
Second Mortgage
Mortgage lender name
Mortgage servicer name
Loan #
Current Interest Rate
Monthly Principal and Interest
Mortgage maturity date
Original mortgage balance
Unpaid Principal Balance
Number of Months in Arrears
GSE Loan Type?
Please select...
Fannie Mae
Freddie Mac
FHA
VA
FHA #
Total Amount of Arrears
Number of Months in Arrears
Do you have any liens or nonmortgage loans on the property?
Please select...
Yes
No
Lien or Nonmortgage Loan
Lien Name
Monthly payment
What is the total amount owed on the liens?
Unpaid Principal Balance
Payoff date
Servicer
name
Total Amount of Arrears
Number of Months in Arrears
Additional Property Information
Estimated Property Value
Monthly property tax
Monthly Association Fee
Monthly
Insurance
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Contact Information