Foreclosure Prevention Intake Form

Please complete and submit this form in order to receive foreclosure prevention counseling services. You will be contacted by a housing counselor to schedule an office appointment. We will evaluate your situation, explain your options, and help you apply for the Making Home Affordable Program. This counseling is FREE to residents of Central Brooklyn. Bridge Street Development Corporation is a 501(c)3 nonprofit community-based organization and is a HUD-approved housing counseling agency.

About You

Please tell us about yourself.


Counseling is made possible through grants. By filling out this form you are authorizing the provider to share the information on this form with their funders. Information will be used solely to evaluate programs and to find out the characteristics of whom the program is serving. Personal information will never be shared and will be treated with confidentiality.

First Name*
Middle Name
Last Name*
Date of Birth
State / Province*
Confirm Email*
Where Employed*

About Your Home

Please tell us about your foreclosure situation. The more detail you provide to our counselors, the better able they will be to help.

Co-Borrower Name
Number of People in the Household
Reason for Hardship/Please briefly describe your situation*
Additional Comments

Security Code