Student Application

Applicant Information

• Applicant's Name
• E-mail
• Cell Phone
• Telephone
• SSN or Passport Number
• What Room Would You Like?

Current Address

• Current Address
• How Long at Current Address
• Name of Landlord at Current Address
• Telephone of Landlord at Current Address

Previous Address

• Previous Address
• How Long at Previous Address
• Name of Landlord at Previous Address
• Telephone of Landlord at Previous Address

Bank Information

• Bank Name
• Bank Address

Rent Payment

• Who will pay the rent? -- self friend family student loan other

Student Information

• School Name
• Current Year
• Graduating
• School ID

Applicant's Employment Information

• Applicant's Employer (or source of funds)
• Employer's Telephone
• Supervisor Name
• How long have you been employed?
• Income (ex. $500 per week)

Parents' Information

• Parent Name
• Parent Phone
• Parent E-mail
• Parent Name
• Parent Phone
• Parent E-mail
• Parent's Address
• How Long
• Parent's Employer

Automobile

• Car Make and Model
• Car Year
• License Plate Number
• License Plate State

In Case of Emergency

• Name of Emergency Contact
• Telephone of Emergency Contact