Assistance Request Form
If you are having mortgage payment challenges due to a hardship related to COVID-19, please complete the form below.


We will contact you within five business days to acknowledge receipt of form submission and let you know if we need any additional information. We will use the information you provide to help us identify the assistance you may be eligible for. If you need help completing this form, please contact us at 800.922.0446, extension 1117.

Borrower Information

Preferred Contact Method (choose all that apply) *

Co-Borrower Information

Preferred Contact Method (choose all that apply)

Property/Loan Information 1

Loan Type *
Property is currently *
The Property is (select all that apply) *

Property/Loan Information 2

Loan Type
Property is currently
The Property is (select all that apply)

Hardship Information

Borrower Certification and Agreement

(1) I certify and acknowledge that all the information in this Mortgage Assistance Request is truthful, and the hardship I identified contributed to my need for the mortgage relief. Knowingly submitting false information may violate Federal and other applicable law. (2) I agree to provide SC Telco FCU with any supporting documentation as requested and will respond in timely manner. (3) I acknowledge and agree that SC Telco FCU is not obligated to offer me assistance based solely on the representations in this document or other documentation submitted in connection with my request. (4) I consent to SC Telco FCU obtaining a credit report for the borrower and co-borrower. (5) I understand that if I default under any term(s) of the Modification Agreement then the terms of the Modification shall be rescinded, and all terms of the Original Note and Security Instruments shall govern upon default as though the Modification had not been entered into. (6) I consent to being contacted concerning this request for mortgage assistance at any telephone number (including mobile numbers) or email address I have provided. By selecting yes and submitting this form electronically, you certify and acknowledge all terms and conditions of this agreement. *