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Personal Information
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First Name
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Last
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Cell
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Currently Living
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Home
On Campus
Off Campus
Address
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Home #
*
SSN
(can be remitted separately by e-mail or regular mail)
Date of Birth
*
Email
*
Rank
*
Freshman
Sophomore
Junior
Senior
Grad
Graduation Year
Major
Parental / Guarantor Information
Father's Name
Last
SSN
Employment
Occupation
Office #(Ext)
Address
Home #
Cell
Fax
E-mail
Mother's Name
Last
SSN
Employment
Occupation
Office #(Ext)
Address
Home #
Cell
Fax
E-mail
Will Parent(s) or Guarantor(s) agree to pay the rent?
Yes
No
Property of interest (list here)
1st
Bathgate Houses
Belmont Townhouses
Hoffman Houses
Lorillard Houses
Lorillard Tower
Rose Hill Houses
2nd
Bathgate Houses
Belmont Townhouses
Hoffman Houses
Lorillard Houses
Lorillard Tower
Rose Hill Houses
3rd
Bathgate Houses
Belmont Townhouses
Hoffman Houses
Lorillard Houses
Lorillard Tower
Rose Hill Houses
4th
Bathgate Houses
Belmont Townhouses
Hoffman Houses
Lorillard Houses
Lorillard Tower
Rose Hill Houses
Period Wanted (Approximate)
Starting date:
Ending Date
Proposed Roommates (if already known)
Full Name
Cell
E-mail
Full Name
Cell
E-mail
Full Name
Cell
E-mail
Full Name
Cell
E-mail
Full Name
Cell
E-mail
Self Employed Applicants
Company Name
Salary:
Supervisor's Name
Phone #
Attachments
Copy of any picture ID is fine
Can be remitted separately by e-mail or regular mail
Clause
"Applicant affirms all above information to be true and accurate. Applicant understands that, if found false, misleading or incomplete, tenancy can be denied or terminated with loss of deposit. Landlord can contact parent(s) or guarantor(s) for payment of rent and for any other matter related to tenancy. Landlord, if requested, can release information about tenant to representative of college attended by tenant and to any local, state, or federal authorities. Tenant agrees to all above." NOTE: Please send application by e-mail and mail a signed copy with the reservation deposit of $600.00 (made payable to Dr. P. Perretta) to above address. Said deposit shall be fully refundable ‘till applicant has confirmed intent to rent a specific unit.
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