Test for Revised TTK Interest Form Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhonePhone *Alternate phoneEmail *EmailConfirm EmailDo you own your current home? *YesNoHow many years have you owned your current home?Total annual gross household income from all household members and income sources *Number of people in your household including yourself, all adults, and children *123456789+Do you currently work for the City of Philadelphia? *YesNoHow many years of service do you have with the City?Do you have a City of Philadelphia payroll number?YesNoName of Department or AgencyAre you a?Permanent full-time employeePart-time employeeTemporary employeeSeasonal Employee Who administers your City of Philadelphia Medical Benefits?City Administered Plan (CAP)DC33DC47PoliceFireI don't have medical benefitsI am covered under a spouse/partner's medical benefitsI don't knowAre you a contract employee for the City of Philadelphia? *YesNoName of Department or AgencyName of EmployerAre you a PHA resident?YesNoWe are building houses on publicly-owned land across the city. Some locations will be completed later in the year. Please indicate your location preferences below the map. ChoicesFirst Choice *BelmontBrewerytownCarroll ParkEast KensingtonGrays FerryHunting ParkLudlowNorris SquareNorth CentralStrawberry MansionWest PoplarWhartonNone of the above2nd Choice *BelmontBrewerytownCarroll ParkEast KensingtonGrays FerryHunting ParkLudlowNorris SquareNorth CentralStrawberry MansionWest PoplarWhartonNone of the above3rd ChoiceBelmontBrewerytownCarroll ParkEast KensingtonGrays FerryHunting ParkLudlowNorris SquareNorth CentralStrawberry MansionWest PoplarWhartonNone of the aboveHave you received a housing counseling certificate from a City-funded Housing Counseling Agency? *YesNoHave you attended a Turn The Key Informational session? *YesNoReferred by? *APMBMKBVGCity of PhiladelphiaCivetta Property GroupDC33DC47Fine Print ConstructionFrankel EnterprisesHACEPHDCPhiladelphia Workforce HomesOtherIf you chose other, please let us know how you heard about the Turn The Key initiative. If you have already completed housing counselling, it must have been in the past 12 months. If so, contact Ashley.stukes-martin@phdc.phila.gov to verify. In order to continue with this phase of the process, PHDC requires your consent to share the following information (collectively, the "Personal Information") with certain non-affiliated housing counseling agencies and other entities (collectively, the "Housing Counseling Agencies") that perform support services for PHDC in connection with the Turn the Key initiative, including, among other things, housing counseling, income certification and credit reviews:Personal Information Your name Your current address Your phone number Your email address Your homeownership status Your total annual gross household income from all household members and income sources The number of people in your household including yourself, all adults, and children Whether you work for the City of Philadelphia, and if so, the nature of your employment. Your location preferences for housing through the Turn the Key Initiative Whether you have attended a Turn the Key Informational session The agency, entity or individual, if any, who referred you to the Turn the Key initiative and/or how you heard about the Turn the Key Initiative. The Housing Counseling Agencies are required to ensure the confidentiality of your Personal Information by holding it in strict confidence in a secure location (24 CFR 214.315), and may be subject to the penalties provided in the Fair Credit Reporting Act (14 U.S.C. 1681) for failure to do so. The Housing Counseling Agencies may use your Personal Information only in the course of providing services under the Turn the Key initiative, and only for such purposes as PHDC shall instruct the Housing Counseling Agencies. Other than as described herein, PHDC will not disclose any of your information, including your Personal Information, to any third parties, and PHDC will share your Personal Information with the Housing Counseling Agencies only with your express consent. The retention and disclosure of your Personal Information by PHDC will be undertaken in accordance with PHDC's privacy policy, which can be found here.Please check one of the following boxes to indicate whether you consent to PHDC's sharing of your Personal Information with the Housing Counseling Agency.I hereby consent to PHDC sharing my Personal Information (as defined above) with the Housing Counseling Agencies (as defined above) for the purposes described above.I do not consent to PHDC sharing my Personal Information (as defined above) with the Housing Counseling Agencies (as defined above) for the purposes described above. I understand that by not consenting to PHDC sharing my Personal Information, I will be required to provide PHDC with a Housing Counseling Certificate within fourteen (14) days of receipt of this correspondence. WebsiteSUBMIT
