Phoenix Square Housing Application

To apply for the Phoenix Square Housing at Time for Change Foundation please use this form and we will be in touch shortly.

Personal Information

First Name *

Mid. Int. *

Last Name *

Email *

Address *

City & State *

Zip *

Home Number *

Alter. Number *

Date of Birth *

SSN *

Current Occupancy

Dates of Current Occupancy *

Monthly Rent *

Do youRentOwnRent but not in my nameOther

Landlord of Management Name *

Home Number *

Address *

City & State *

Zip *

Former Address (Within 2 years)

Address *

City & State *

Zip *

Did youRentOwnRent but not in my nameOther

Landlord of Management Name *

Home Number *

Employment: (Proof May Be Required)

Employer *

Address *

Phone Number *

Occupation *

Hire Date *

Weekly Gross Salary *

Additional Employment (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 Only

School Name *

Address *

Program *

Graduation DateGradUnder GradFull-TimePart Time

Can you have a co-signer?YesNo

Address & Unit Applied For

Address *

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?

YesNo

Have you ever been evicted from a rental residence?

YesNo

Have you had two or more late rental payments in the past year?

YesNo

Have you ever willfully or intentionally refused to pay rent?

YesNo

How did you hear about us? *

The above information, to the best of my knowledge, is true and correct.

Personal Information

Current Occupancy

Former Address (Within 2 years)

Employment: (Proof May Be Required)

Additional Employment (Other or Current Job Less Than 1 Year)

Students Only

Address & Unit Applied For

Reference (Preferably Local)

Emergency Contact (if different from above)

Rialto High School NJROTC to be honored with the Ramos Family Spirit of Compassion Award

Dr. Rita (Faridah) Ali to be honored with the Humanitarian Award

Pastor Craig Hadley to be Honored with the Nancy Varner Angel Award