All fields are required.


First Name

Middle Initial

Last Name


Social Security Number

Date of Birth

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Phone Number

Email Address

Permanent Address

Temporary Address (if applicable)

Drivers License Number


State Issued

School Attending (if applicable)


Anticipated Graduation Date

Select a date or enter manually:

How did you hear about us?



Present Employer

Employer Phone Number

Employer Address


Length of Employment

Monthly Income



Guarantor Name

Guarantor Address

Daytime Phone Number

Evening Phone Number

Guarantor Email Address



Have you ever been convicted; plead guilty; plead no contest; received probation, deferred adjudication, court-ordered community supervision or pre-trial diversion for a felony (whether or not resulting in a conviction)?

Have you ever been convicted; plead guilty; plead no contest; received probation, deferred adjudication, court-ordered community supervision or pre-trial diversion for a misdemeanor involving violence or sexual misconduct (whether or not resulting in conviction)?



Have you ever been evicted or asked to move out from a previous landlord?

Do you currently owe any outstanding balance (s) to a previous landlord?



In case of Emergency, notify:



Phone Number


Alternative Phone Number



Email Address




I certify all of the above information is true and complete. I acknowledge that false information herein may constitute grounds for rejection for this Application, termination of right of occupancy and non-return of fees and deposits.


I hereby authorize Owner to use reasonable and necessary means, including any credit reporting agency, current and previous employer, current and former landlord, law enforcement agency, any check authorization agency, and state employment security agency, to release all information any of them may have about me. I hereby release all of these parties, including but not limited to the Owner and any agency designated by Owner, from any liability in connection with release of such information. I hereby authorize Owner to obtain and hereby instruct any credit reporting agency designated by Owner to furnish a credit report under The Fair Credit Reporting Act to Owner to use such credit report in attempting to collect any amounts due and owing under the Housing Contract or   the Guaranty of Resident Obligations or for any other permissible purpose.


I hereby pay to Owner a Non-Refundable Application Fee for processing this Application. I acknowledge the Non-Refundable Application Fee shall not be refunded for any reason.


I hereby pay to Owner a Non-Refundable Administration Fee for processing the Housing Contract. I acknowledge that this fee does not assure me of a Housing Contract or bedroom. In the event a bedroom cannot be leased to Applicant or if the Application is not approved, the Non-Refundable Administration Fee will be refunded. If the Application is withdrawn within 72 hours after signing this Application, the Non-Refundable Administration Fee will be refunded. In order to withdraw this Application, I must provide written notice to Owner and such notice will only be effective on the date Owner actually receives such notice. If I do not enter into the Housing Contract for any reason, the Non-Refundable Administration Fee will be retained as liquidated damages by Owner.


If I cannot prove income and/or do not meet the qualifying credit history, I will obtain a Guarantor who will sign a Guaranty of Resident Obligations. In the event I submit an executed Housing Contract but do not submit an executed Guaranty of Resident Obligations as and when required by Owner, Owner shall have the right to require me to honor my obligations under and comply with all obligations of the Housing Contract. All applicants must be 18 years of age or older to apply for housing.


By signing below I represent that I have read and agree to all provisions of this Application.

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Signature Certificate
lock iconUnique Document ID: e384b5953750ff05bb6e1d95600e0bc5b18099ba
Timestamp Audit
April 8, 2016 4:39 pm CDTHOUSING APPLICATION Uploaded by Zac Sandefer - armand.tmd@gmail.com IP