Pre-Home Ownership Education Course:
Interview Registration

For All Time Zones, call:  Winston-Salem, CCCS Office Phone # (877)FOR-RMIC (367-7642)   Fax # (336) 896-1927 Email: prehome.rmic@cccsforsyth.org
 
Contact Name:   with                 Lender   or   Broker
  Please indicate the company that will be responsible for payment of counseling if not insured by RMIC or if mortgage is Emerging markets product.
    Lender  or   Broker is responsible for payment
 
Lender Information:
Lender Name   RMIC Master Policy #
Mailing Address   
City   State                         Zip                
Phone   Fax:
MI Requirement:
Loan Type:
Uninsured  Insured by RMIC     Emerging Markets
97% LTV  95% LTV FHA/VA/USDA
Closing Date:   Lender Email:
  Lender Note: This Interview Registration Form should be faxed or e-mailed to CCCS at least two (2) working days before verification is expected. Please complete the Expense Analysis Form and the Content Review Form prior to counseling. If the borrower does not have access to a phone for CCCS to initiate the call, please call or email CCCS to make arrangements with a CCCS counselor.
Broker Information:
Broker Name 
Broker Mailing Address
City  State        Zip 
Broker Phone Broker Fax:
Broker Email:
Borrower Contact Information:
Borrower Name   Social Security #
Co-Borrower Name   Social Security #
Street  
City   State                         Zip                
Home Phone   Work Phone
Email:
  Borrower Note: Training verification (not a test) requires a 15-30 minute interview by a CCCS counselor with the borrower. Only one borrower must complete the interview.
Appointment Information:
Check if needed:  
  Spanish-Speaking Counselor  
  Assistance for Hearing Impaired  
  Landlord Counseling    
   
Time Zone: Eastern Central Mountain Pacific
Day: Monday Tuesday Wednesday Thursday Friday
Place: Home Work
Time: 8:30 am - 12 noon 12 Noon - 3:00 pm 3:00 pm - 5:00 pm
 
Within each time zone, counselors will be available 8:30 a.m. - 5 p.m. Holidays and weekends are excluded.

 
Borrower Authorization: If I fail to make any monthly mortgage payment as agreed, I understand that the servicer of my mortgage loan may refer me to a third-party counseling organization or a mortgage insurer, which will advise me about finding ways to meet my mortgage obligation. I hereby authorize the servicer to release certain information related to the servicer’s own experience with me to such third-party counseling organization or mortgage insurer, and request that the counseling party contact me. I further hereby authorize the third-party counseling organization of mortgage insurer to make a recommendation about appropriate action to take with regard to my mortgage loan, which may assist the servicer in determining whether to restructure my loan or to offer extraordinary services that could preserve my long-term home ownership.
Borrower’s Signature Date                     Co-Borrower’s Signature Date
Special Note: The act of submitting this registration form via e-mail will imply full Borrower Authorization as described in the preceding paragraph.
   
     
We now offer the option to pay in advance for the homebuyer education course.