Reverse Mortgage Registration

Home Reverse Mortgage Registration

Reverse Mortgage Registration

Name
First Last
What county do you currently live in?*
Physical Address*
Street Address Address Line 2 City State ZIP Code
Phone
Email
Enter Email Confirm Email
Date of Birth*
MM slash DD slash YYYY
How did you hear about us?
Marital Status
Highest Education Level
Active Military?
Military Veteran?
Are you disabled or disabled dependent?
What is your race?
What is your ethnicity?
Indicates if you are Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Gender
- Male
- Female
What is your English proficiency level?
Do you rent or own?
Would you like more information on becoming a first-time homebuyer?
What is the size of your household?
The number of people currently residing in your household (e.g. the number of people living in the house at the time service was provided).
Please enter a number from 0 to 50.
What is your annual family or household income?
The household gross (pre-tax) income during the year as reflected in your loan or grant application.
Please enter a number from 0 to 500000.
Privacy Notice Opt-out? (By opting out, you may not be eligible for some services)
- Yes
- No
Do you have a spouse?
If so, your spouse needs to be in the counseling session with you.
- Yes
- No
Is there anyone else living with you?
- Yes
- No
If so, what is their relationship?
Is there a Power of Attorney (POA) or Guardian involved?
- Yes
- No
Do you have a Trust?
- Yes
- No
If so, what kind of Trust?
Please download and complete the required documents:
HECM COUNSELING INTAKE PACKAGE (2026)-without the financial assessment
HECM Financial Assessment - Excel Format
Please upload the following documents to ensure your intake appointment goes smoothly.
Client Documents
Government issued Photo ID
Copy must be legible
Max. file size: 128 MB.
One Utility Billing Statement
Most recent statement received (Electric, Gas, or Water)
Max. file size: 128 MB.
Reverse Mortgage Statement
if this counseling is for Reverse Mortgage refinance
Max. file size: 128 MB.
Power of Attorney (POA), Trust, Guardianship
If Applicable
Max. file size: 128 MB.
Lender Documents
Loan Comparison
Drop files here or

Max. file size: 128 MB.
Total Annual Loan Cost (TALC)
Drop files here or

Max. file size: 128 MB.
Amortization Table
Drop files here or

Max. file size: 128 MB.
Estimated costs
Drop files here or

Max. file size: 128 MB.
Signed Disclosures
(Click Here to download Intake Package)
Drop files here or

Max. file size: 128 MB.
I acknowledge that I have read the <a href="https://firsthomealliance.org/agencydisclosures/">Agency Disclosures Form</a>*
I acknowledge that I have read the Agency Disclosures Form*
Full Name
First Last
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Reverse Mortgage Registration

Reverse Mortgage Registration

Client Documents

Lender Documents