Housing Verification

Housing Verification

Life Changes, Inc.
Housing Statement
Client Name

First NameLast Name
Move In Date:   Date*

To Whom It May Concern:

First Name*   Last Name*   is a resident of the Life Changes, Inc. residential program. The program fees are $175 weekly. This is a live-in program and the fees include utilities and household sundries. The residents supply, store and prepare their own food separately.

Address:   Street Address*      City*   State*   Zip*

Phone #:   Area Code*   Phone Number*
Staff Name*

First NameLast Name
Staff Email*
example@example.com
Staff Phone Number*
Please enter a valid phone number.
Staff Signature*

Clear
Should be Empty: