Intake Form

As part of an introductory process, an Intake Form is needed to collect information so that PHOS representatives can guide you throughout the application and mortgage process.

Introductory Questionaire

Once you complete the form, PHOS staff will reach out to have a phone consultation.

First Name

Last Name

Penn/UPHS ID Number

Home Phone

Cell Phone

Work Phone

Address

Address (line 2)

Second line of address

City

State

Zip Code

Preferred Method of Contact

Salutation

Ms.

Mrs.

Mr.

Suffix

Penn Employment Status

Years at Penn or other Eligible Institution

Exempt Status

Exempt

Non Exempt

Affiliation

Start date (Penn employees only)

Position Title (Penn Employees Only)

School/Center/Department (Penn employees only)

First Time Homebuyer

Yes

First time applying to PHOS

Yes

Penn Position Type

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Introductory Questionaire

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