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Mortgage Assistance Program Application

  • Last NameFirst Name, Middle InitialRelationship to ApplicantDate of BirthRaceEthnicity 
  • First Mortgage Information

  • Date Format: MM slash DD slash YYYY
  • Second Mortgage Information

  • Date Format: MM slash DD slash YYYY
  • Household Income and Assets

  • EmployerPositionAddressContact PersonPhone NumberAffected by COVID-19? 
  • Type of IncomeWho receives it?Amount Recieved in the last 30 Days? 
  • InstitutionAccount NumberCurrent Balance 
  • COVID-19 Statements

  • I (we) hereby submit this application for the Mortgage Assistance Program. I (we) certify that all of the foregoing information is true and complete to the best of my (our) knowledge, and hereby give my (our) permission to the HomeOwnership Center of Greater Dayton (HOC) to conduct further mortgage and financial investigation, as deemed necessary to determine eligibility. Furthermore, I (we) agree to abide by the eligibility and program requirements set forth in connection with any opportunities that may be offered to me (us) by the HOC pursuant to this application. I (we) understand that false, inaccurate, or incomplete information in the foregoing application shall be considered cause for me (us) to be disqualified from participation in the HOC Mortgage Assistance Program, and I (we) must immediately notify the HomeOwnership Center of any material change in our circumstances prior to receiving assistance.

    I (we) understand that we are applying for financial assistance for a property that is my (our) primary residence. I (we) represent that the property will not be used for any illegal or restricted purpose. The applicant(s) understand that the program requirements include restrictions that are subject to change and that submittal of an application is not a guarantee of funding assistance.

  • The following documents MUST be submitted before The HomeOwnership Center can evaluate eligibility:

    • Photo identification of the applicant(s) (i.e. driver’s license)
    • Most recent mortgage statement that shows principal, interest and current amount due + any recent correspondence from your lender on all mortgages on the property
    • Documentation or explanation of COVID-19 related financial hardship
    • Income documentation for all household members (any and all that apply: paystubs for last 30 days, Unemployment Determination Letter, Social Security award letters for current year, Award letters or statements verifying child support, alimony, pension, disability, etc.
    • Social Security card for each household member
    Please call us if you have questions about the program or required documents: 937-853-1600.

  • Drop files here or
  • This program is made possible by funding from the Ohio Coronavirus Relief Fund - Home Relief Grant Emergency Services Program through a grant to the Miami Valley Community Action Partnership.



130 West Second Street

Suite 1420

Dayton, OH 45402

937.853.1600

[email protected]

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