NJ Judiciary Foreclosure Mediation Program
NEW! You may participate in the NJ Judiciary Foreclosure Mediation Program if you meet all of the following eligibility conditions:
- You have wages or income to fulfill a possible mortgage loan workout.
- The property is your primary residence, which is a one- to three-unit residential property.
- You are the borrower and your mortgage loan is being foreclosed.
- You own no other real property.
- You are not in bankruptcy, or, if you filed for bankruptcy, the petition is discharged, dismissed or the bankruptcy stay has been lifted to allow the foreclosure to proceed.
Check here if you meet all of the eligibility conditions listed above.
Check here if you were referred by the State's Mediation Hotline.
Contents of This Web Page
Thank you for your interest in our Loan Counseling Service! The single Loan Counseling Service Application on this page is now used by all four services: (1) General Loan Counseling Service, (2) Reverse Mortgage Counseling Service, (3) Loan Crisis Counseling Service for defaulted mortgages, foreclosures, crisis and predatory workout counseling, and (4) Home Improvement Counseling Service. In Part 1 below, you will "Select the Type of Loan Counseling Service You Want."
Please fill in as much information on the form below as possible. PLEASE NOTE that all applicants must complete Parts 1, 2, 3, 4, and 6; in addition, Home Improvement Counseling Service applicants must also complete the final question in Part 4, while Loan Crisis Counseling Service applicants must also fill out Part 5.
If you have any questions, the final section tells how to contact us by e-mail, phone, fax, and postal mail. We also include instructions on submitting the completed form, either directly by using the Submit button at the end, or you can print it and then mail or fax the filled-in application to us.
Your application will be forwarded to a Loan Counselor as soon as we receive it. You should receive a response from your counselor in two to three weeks. Crisis counseling applicants will be contacted within 48 hours after your application has been processed. Your counselor will set an appointment to meet with you in the office of your choice; our offices throughout NJ are listed in Part 6 below. You should bring as much financial information as possible to your meeting.
We look forward to working with you and hope that you will soon join the thousands of successful New Jersey Citizen Action Loan Counseling Service homeowners! |
Part 1: Tell Us About Yourself |
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Information will not be shared with any third party (e.g., credit agency or lender) without your explicit signed authorization.
"Client 1" refers to the primary applicant, "Client 2" (if applicable) refers to the spouse or co-signer. |
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Select the Type of Loan Counseling Service You Want |
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General Loan Counseling Service |
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Reverse Mortgage Counseling Service |
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Loan Crisis Counseling Service (for Defaulted Mortgages, Foreclosures, Crisis and Predatory Workout Counseling) |
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Home Improvement Counseling Service |
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Foreclosure Mediation Counseling |
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General Information |
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Client 1 |
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Client 2 |
| Last Name |
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| First Name |
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| Middle Name |
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| Suffix (Sr., Jr., etc.) |
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| Social Security Number |
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| Home Phone |
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| Alternate Phone |
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| Email Address |
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| Birth Date |
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| Number of Dependents |
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| Gender |
Female
Male |
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Female
Male |
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| Marital Status |
Married |
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Married |
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Separated |
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Separated |
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Single |
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Single |
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| Additional |
Single Head of Household |
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Single Head of Household |
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Female Head of Household |
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Female Head of Household |
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First Time Home Buyer |
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First Time Home Buyer |
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US Veteran |
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US Veteran |
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Owned Home in Last 3 Years |
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Owned Home in Last 3 Years |
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| Race |
American Indian/Alaskan Native |
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American Indian/Alaskan Native |
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Asian/Pacific Islander |
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Asian/Pacific Islander |
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Black/Non-Hispanic |
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Black/Non-Hispanic |
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Hispanic |
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Hispanic |
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White/Non-Hispanic |
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White/Non-Hispanic |
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Other |
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Other |
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| Citizenship |
US Citizen |
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US Citizen |
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Permanent Resident |
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Permanent Resident |
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Non-Resident |
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Non-Resident |
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Part 2: Address & Employment |
Address |
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Client 1 |
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Client 2 |
| Street Address |
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| City |
State
Zip
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State
Zip
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| Residency Status |
Own
Rent |
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Own
Rent |
| County |
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| Length of Occupancy |
Years
Months
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Years
Months
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Previous Address |
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Enter if the current address is less than two years. |
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| Street Address |
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| City |
State
Zip
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State
Zip
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| Residency Status |
Own
Rent |
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Own
Rent |
| County |
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| Length of Occupancy |
Years
Months
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Years
Months
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Employment |
| Employer Name |
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| Street Address |
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| City |
State
Zip
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State
Zip
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| Contact Phone |
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| Position/Title |
Self-Employed |
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Self-Employed |
| Length of Employment |
Start Date
End Date
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Start Date
End Date
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Previous Employment |
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Enter if within the last two years. |
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| Employer Name |
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| Street Address |
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| City |
State
Zip
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State
Zip
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| Contact Phone |
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| Position/Title |
Self-Employed |
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Self-Employed |
| Length of Employment |
Start Date
End Date
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Start Date
End Date
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Part 3: Financials |
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Income |
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Owner |
If there are multiple clients, enter the name of the one responsible for the income. |
Type of Income |
Specify the type of income: salary, commissions, bonuses, etc. |
Pay Cycle |
Indicate how frequently the client receives this income: biweekly, hourly, monthly, semi-monthly, weekly, or yearly. |
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| Owner |
Type of Income |
Amount |
Pay Cycle |
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| Owner |
Type of Income |
Amount |
Pay Cycle |
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| Owner |
Type of Income |
Amount |
Pay Cycle |
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| Owner |
Type of Income |
Amount |
Pay Cycle |
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| Owner |
Type of Income |
Amount |
Pay Cycle |
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Assets |
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Owner |
If there are multiple clients, enter the name of the one who owns the asset. |
Type of Income |
Describe the nature of the asset: checking account, savings account, stock, pending tax refund, etc. |
Institution |
Enter the name of the bank or other financial institution holding the asset. |
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| Owner |
Type of Asset |
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| Institution Name |
Account Number |
Asset Value |
Available Funds |
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| Owner |
Type of Asset |
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| Institution Name |
Account Number |
Asset Value |
Available Funds |
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| Owner |
Type of Asset |
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| Institution Name |
Account Number |
Asset Value |
Available Funds |
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| Owner |
Type of Asset |
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| Institution Name |
Account Number |
Asset Value |
Available Funds |
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| Owner |
Type of Asset |
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| Institution Name |
Account Number |
Asset Value |
Available Funds |
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Liabilities |
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Owner |
If there are multiple clients, enter the name of the one who has the liability. |
Type of Liability |
Describe the nature of the liability: credit line, mortgage, taxes, etc. |
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| Owner |
Creditor Name |
Monthly
Payment |
Account Number |
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Type of Liability |
Balance Owed |
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Delinquent |
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| Owner |
Creditor Name |
Monthly
Payment |
Account Number |
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Type of Liability |
Balance Owed |
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Delinquent |
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| Owner |
Creditor Name |
Monthly
Payment |
Account Number |
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Type of Liability |
Balance Owed |
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Delinquent |
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| Owner |
Creditor Name |
Monthly
Payment |
Account Number |
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Type of Liability |
Balance Owed |
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Delinquent |
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| Owner |
Creditor Name |
Monthly
Payment |
Account Number |
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Type of Liability |
Balance Owed |
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Delinquent
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Declarations (Credit Issues) |
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Owner |
If there are multiple clients, enter the name of the one who had the issue. |
Action Type |
Specify one of the following: bankruptcy, foreclosure, judgement, lien, party to lawsuit, or repossession. |
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| Owner |
Action Type |
Date Occurred |
Resolution Date |
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| Owner |
Action Type |
Date Occurred |
Resolution Date |
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| Owner |
Action Type |
Date Occurred |
Resolution Date |
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Non-Traditional Credit |
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Owner |
If there are multiple clients, enter the name of the one responsible for this credit. |
Credit Type |
Specify one of the following: auto insurance, cable TV, child care, electric, gas, homeowner/renter's insurance, life insurance, local merchant account, medical bill, medical insurance, rent, school tuition, telephone, or water. |
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| Owner |
Credit Type |
Avg. Monthly
Payment |
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Documentation Provided |
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| Owner |
Credit Type |
Avg. Monthly
Payment |
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Documentation Provided |
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| Owner |
Credit Type |
Avg. Monthly
Payment |
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Documentation Provided |
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| Owner |
Credit Type |
Avg. Monthly
Payment |
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Documentation Provided |
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| Owner |
Credit Type |
Avg. Monthly
Payment |
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Documentation Provided |
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Part 4: Additional Questions |
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How did you hear about New Jersey Citizen Action? Please include the person's name and phone number. |
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If you were referred by a bank, please list the name and phone number of the person you are working with. |
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Were you referred by Legal Services Hotline (888) 989-5277?
Yes
No
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Do you require a Spanish-speaking counselor?
Yes
No
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How would you rate your overall credit?
Poor
Fair
Average
Good
Excellent
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Do you use oil to heat your home or apartment?
Yes
No
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| NEXT QUESTION, about repairs, is ONLY for Home Improvement Counseling Service applicants:
What repairs need to be done? |
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Part 5: Additional Questions — ONLY for Loan Crisis Counseling Service Applicants
Our Loan Crisis Counseling Service is for Defaulted Mortgages, Foreclosures, Crisis and Predatory Workout Counseling |
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| 1. What is the name of the company that sold you your home? |
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| 2. What is the name of the company that financed your home/gave you your mortgage? |
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| 3. Did you have an attorney at your closing? (If yes, did you hire the attorney on your own, or was the attorney recommended to you by the seller/lender)? |
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| 4. Were you charged high interest rates? (If yes, was this the rate you were promised by the lender?) |
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| 5. Were you charged a high loan fee, points, or other charges upfront? |
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| 6. Were you sold costly and unnecessary insurance policies upfront? |
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| 8. Are your monthly payments different than what you were told by the lender/seller? |
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| 9. After purchasing your home, did you find out that there were unpaid taxes or utility bills from previous owners? |
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| 10. Did the company that financed your home repeatedly refinance you? (If yes, did your payments increase after each refinance?) |
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| 11. Did a contractor/repairman recommend a lender to finance your repairs? |
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| 12. Were any promises made by the lender/seller that were not kept? |
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| 13. To your knowledge, was any information falsified or were any signature(s) forged on your closing documents? |
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Part 6: Select an Office Location
Please choose the office that you would like to go to: |
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Camden |
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Highland Park |
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Jersey City |
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Newark |
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Passaic |
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Paterson |
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Plainfield |
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Rahway |
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Trenton |
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If you prefer, you may also print out this form, using your Web browser's Print command (be sure the cursor is within the form itself), complete it and send it to the Postal Mail address given directly above. Or you can Fax it to us at 973-643-8100. Thank you!
This form is for use by applicants from both New Jersey Citizen Action (NJCA) and the New Jersey Citizen Action Education Fund (NJCAEF).