Student Rental Application
271 E. 12th. Street
Personal Information:
Applicants Name: _______________________________ ______ _____________________
(Last) (M) (First)
Social Security Number: __________________________
Date Of Birth: __________/__________/_______________
(Month) (Day) (Year)
Drivers License Number: __________________________
Phone Numbers: _____________________________(mobile)
_____________________________(home)
E-Mail Address: ________________________________________
Address:
Present Address: _________________________________________________________________
City: ____________________ State: ______________ Zip: ________________
Landlord’s name: __________________________________ Phone Number: __________________________
Address (when not at school): ____________________________________________________________
City: ____________________ State: ______________ Zip: _________________
Employment History:
Current Employer: __________________________________ How Long Employed: _______________
Contact Person: _____________________________________ Phone Number: ______________________
Gross Monthly Wages: _______________________________
*Will Parents be helping with rent? ______________________________
Nearest Relatives: (for emergency purposes)
Name: __________________________________________ Phone Number: ____________________
Name: __________________________________________ Phone Number: ____________________
_____________________________________________ __________________________
Signature Date