FAMILY SERVICES CENTER - City of Phoenix, AZ
FAMILY SERVICES CENTER
Documents Needs Checklist Please bring the items checked below to your next appointment
Client Name:______________________________________
1. Proof of all gross income for the last thirty (30) days [from:_________ to:________], including current year Social Security award letters and Pell Grants distribution, for everyone in your household, and employer name and telephone number, if applicable. Verification of full-time student status is also required If a household member(s) is 16 or 17 years of age and has earned income.
___________________________________________________________________________
2. Picture I.D. for the following person (s) ____________________________________________________________________________
3. Social Security card or official document with Social Security numbers for all members in the household ___________________________________________________________________________
4. Birth certificates for:_____________________________________________________________
5. Current unaltered lease agreement, including Landlord's address and telephone number ___________________________________________________________________________
6. Eviction Notice for the current month (if requesting rental assistance) ___________________________________________________________________________
7. Mortgage Statement for the current month, showing past due @ 15 days or more (if requesting mortgage assistance) ___________________________________________________________________________
8. Proof of emergency: Verification/documentation of the cause of your emergency. (Example: receipts for unexpected expenses, doctor statement, police report, letter from your employer, etc.) ___________________________________________________________________________
9. Written verification of all terminated income, including last pay date and employer phone #. ___________________________________________________________________________
10. Written verification of new employment, showing weekly hours, rate of pay, 1st payday, start date, and employer phone number. ___________________________________________________________________________
11. FEI Tax ID#:__________________________________________________________________
12.Most recent utility bills: Water Bill
Electric Bill
Gas Bill
M-Power Receipt
13. Other:_______________________________________________________________________
14. Your next appointment is scheduled on: ______________________________________________with:____________________________________. If you have
any questions you may contact this Caseworker at : 602-______ - _____________
By signing this document, I understand that although I have been scheduled a return appointment, it is not a guarantee that financial assistance will be granted. I also understand if all of the above documents are not submitted, services may not be provided.
Client Signature:________________________________________Date:_______________________
01/2011
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