Back to Protect My KY Home Page
New Client Request
*
indicates a required field
First Name:
*
Middle Name:
Last Name:
*
E-mail:
Property Information
Address:
Zip/City/County:
*
,
KY
Mailing Address
Same as Property Address?
*
Yes
Contact Information:
*
Home Phone:
Work Phone:
Cellular Phone:
Preferred Contact Type:
*
Home Phone
Work Phone
Cell Phone
Email
Mail
Best Time to Call:
*
Morning
Afternoon
What is your current status?
*
Current but anticipating delinquency
30 days late
60 days late
Summons has been served to client
90+ days late
Is property owner-occupied?
*
Select One
Yes
No
How did you hear about us?
*
800#
Billboard
Conciliation Flyer
Counseling Agency
Facebook
Family Member
Friend
Governor's Office
HOPE Line
HUD Agency
KHC Letter
Lawyer/Legal Aid
Lender
Louisville Metro Efforts
Newspaper
Other
Outreach Worker Contact
Pandora
Radio
Rapid Response
Social Worker
SSI/Disability Office
Television
Unemployment Office
Website
Send Application Package via:
Mail
E-Mail Only
"E-Mail Only" will require printing 9+ pages, but will be faster than waiting for it to be mailed
Do you have your loan with Kentucky Housing Corporation?
*
Select One
Yes
No
Are you applying for the Unemployment Bridge Program funds?
*
Select One
Yes
No
Enter the code shown:
Please do not double-click the Save button!