Community Partners for Affordable Housing (CPAH) COVID-19 Mortgage Questionnaire
Upon completion of the form below, our Intake Coordinator will reach out to you within 48 hours with more information.
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First & Last Name: *
CIty & State where property is located: *
Best phone number to reach you: *
Email Address: *
Has your income been affected due to the COVID-19 pandemic? *
Are you or anyone on the loan presently unemployed? *
If you answered "Yes" in the previous question, are you or anyone on the loan currently receiving unemployment benefits?
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Were you behind on your mortgage prior to the pandemic? *
If you answered "Yes" in the previous question, have you received or are you receiving any assistance at this time?  
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Have you reached out to your mortgage servicer? *
Servicer/Lender Name: *
Briefly describe your present situation and the type of assistance you are seeking:
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