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