To apply for the Phoenix Square Housing at Time for Change Foundation please use this form and we will be in touch shortly. Personal InformationFirst Name * Mid. Int. * Last Name * Email * Address * City & State * Zip * Home Number * Alter. Number * Date of Birth * SSN * Current OccupancyDates of Current Occupancy * Monthly Rent * Do youRentOwnRent but not in my nameOtherLandlord of Management Name * Home Number * Address * City & State * Zip * Former Address (Within 2 years)Address * City & State * Zip * Did youRentOwnRent but not in my nameOtherLandlord of Management Name * Home Number * Employement: (Proof May Be Required)Employer * Address * Phone Number * Occupation * Hire Date * Weekly Gross Salary * Additional Employement (Other or Current Job Less Than 1 Year)Employer * Address * Phone Number * Occupation * Hire Date * Weekly Gross Salary * Other Income (alimony, investment, etc) * Amount (per month) * Auto (Make/Year) * Plate # * State * Students OnlySchool Name * Address * Program * Graduation DateGradUnder GradFull-TimePart TimeCan you have a co-signer?YesNoAddress & Unit Applied ForAddress * Apt # * City & State * Apt Size * # Occupants * # Adults * # Minors * Move In Date * Rent Begins * Lease Term (months) * Dates From * Monthly Rent * Pre-Paid Rent * Security Deposit * Deposit Rec'd * Reference (Preferably Local)Name * Address * Phone Number * Name * Address * Phone Number * Emergency Contact (if different from above)Name * Address * Phone Number * Have you declared bankruptcy in the past seven (7) years?YesNoHave you ever been evicted from a rental residence?YesNoHave you had two or more late rental payments in the past year?YesNoHave you ever willfully or intentionally refused to pay rent?YesNoHow did you hear about us? * —Please choose an option—NewspaperFriend's ReferralTelephone DirectoryInternetSign at ApartmentOtherThe above information, to the best of my knowledge, is true and correct.
