Rent Assistance Application

Agency determining assistance:

Society of St. Vincent de Paul- Phoenix,

Family Assistance Ministry (FAM)

Customer Consent  Form Language:

I hereby consent to and authorize The Society of St. Vincent de Paul ("Agency") to access any financial information from any related credit, bank, or other lender accounts concerning payment history, delinquencies, outstanding amounts owed, required deposits, usage history and other related information, and to use such information in connection with my application for financial assistance on this date.  This consent and authorization shall expire following Agency's review of my information for qualification of financial assistance on this date.

Statement of Truth:

Under penalty of perjury and acknowledgement by my signature below, I swear or affirm that the statements made regarding the persons in my home and the income, resources, property and all other items that pertain to my possible eligibility for benefits are true and correct to the best of my knowledge.

Application - Family Assistance Ministry (FAM)
Not complete until Guarantee is made by Resource Center 

Number of People in Household :

income per month

Wages from Working

Social Security Benefits

Food Stamps

Child Support Income

Side jobs/part-time work

Gifts / Other benefits

$

$

$

$

$

$

total income

$

expenses per month

Rent  / Mortgage

Utilities (elec., gas, water

Food

Phone/Internet/Cable

Auto (fuel, fees, etc.)

Bus Tickets

Child Care

Child Support Payment

Loans (auto, credit cards)

Medical / Other

$

$

$

$

$

$

$

$

$

$

total expenses

$

surplus/deficit(-)

$

affidavit

Society of St. Vincent de Paul- Phoenix

As indicated by my signature below, I solemnly swear, under penalty of perjury, that the following statements regarding my eligibility for services and benefits are true and correct to the best of my knowledge. 

Was your crisis caused by the impact of the coronavirus (COVID-19) pandemic?

DOCUMENTS NEEDED:
 

• Photo ID for applicant and ID for all household members.
   

• Proof of income for all adults in the household for the past 30 days (gross income, before any deductions) or state in affidavit 0 income in the past 30 days.
   

• Rental Statement ( must be in applicant’s name)
   

• NOTE: if a Rent Deposit is being requested, proof of U.S. citizenship also needs to be sent

​

IF CRISIS WAS COVID-19 RELATED, PLEASE SEND DOCUMENTS CONFIRMING ANY OF THE FOLLOWING, SUCH AS:

• Notice of job loss from Employer

• Evidence of reduced work hours

• Any hospitalization documents

• Notice of a Quarantine requirement

• Childcare or school unavailability

Additional Documents -two options for sending:

Option 1 - if possible, please use the green "File" buttons below to attach the required files directly to this Application.  All attachments will be automatically included with your Application after clicking the blue "SUBMIT" below.

Thank you!