Phoenix Square Housing Application – Time For Change Foundation

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

Phoenix Square Housing Application

Personal Information

First Name

Middle Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Home Number

Alternate Number

Date of Birth

SSN

Current Occupancy

Dates of Current Occupancy

Monthly Rent *

Do You...

Landlord of Management Name

Home Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Former Address (Within 2 Years)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You...

Landlord of Management Name

Home Number

Employment (Proof May Be Required)

Employer

Occupation

Address

Hire Date

Phone Number

Weekly Gross Salary

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

Employer

Occupation

Address

Hire Date

Phone Number

Weekly Gross Salary

Other Income (alimony, investment, etc)

Auto (Make/Year)

Plate #

State

Students Only

School Name

Address

Program

Graduation Date

Can You Have A Co-signer?

Address & Unit Applied For

Address

Address Line 1

Apt #

City

State

Zip Code

# Occupants

# Adults

# Minors

Move-In Date

Monthly Rent

Rent Begins

Pre-Paid Rent

Lease Term (Months)

Security Deposit

Dates From

Deposit Received

Reference (Preferably Local)

Name

Address

Phone Number

Emergency Contact

If different from above

Name

Address

Phone Number

Have you declared bankruptcy in the past seven (7) years?

Yes

Have you ever been evicted from a rental residence?

Yes

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

Yes

Have you ever willfully or intentionally refused to pay rent?

Yes

How did you hear about us?

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