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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