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.
