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 you RentOwnRent 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 you RentOwnRent but not in my nameOther Landlord 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 Only School Name Address Program Graduation Date GradUnder 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? ---NewspaperFriend's ReferralTelephone DirectoryInternetSign at ApartmentOther The above information, to the best of my knowledge, is true and correct.