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How did you hear about us?
How do you expect to pay your rent? (Loan, Grant, Savings, Work, Parents):
Name:
Maiden Name:
Sex:
Male
Female
Age:
Birthdate:
Email address:
Student ID #:
Do you smoke?
Yes
No
Driver's License #:
State:
International Students -- Country:
Passport #:
Current Address:
What County:
Current Phone #:
Dates at this address:
(For security deposit return)
Permanent address:
What County:
Permanent Phone #:
Are you a student?
Yes
No
Major:
Which school?
U of I
Parkland
Other (specify)
What year are you in school?
When year do you expect to graduate?
Have you lived in an apartment before?
Yes
No
If YES: Most recent -- When/Period?
Address:
What County:
Name and phone # of landlord or manager:
Name:
Phone #:
Next most recent -- When/Period?
Address:
What County:
Name and phone # of landlord or manager:
Name:
Phone #:
If NO: Have you lived in student dorms?
Yes
No
If YES, Please identify:
Name of Resident advisor or reference:
Previous Dorm: Name of Resident advisor or reference:
Employer:
Phone #:
Address:
Position:
Dates of employment:
Reason for leaving:
Employer:
Phone #:
Address:
Position:
Dates of employment:
Reason for leaving:
REFERENCES: (List at least 3 references with name, address, and phone #. These can include:
Previous landlord, Advisor, Counselor, Priest/Minister, or Friend of the Family.)
Name/How known:
Address:
Phone #:
How long known?
Name/How known:
Address:
Phone #:
How long known?
Name/How known:
Address:
Phone #:
How long known?
Name/How known:
Address:
Phone #:
How long known?
IN CASE OF EMERGENCY: (nearest relative or associate in this country)
Name:
Relationship to you:
Address:
Home phone #:
Work phone #:
The applicant hereby authorizes Owner/Owner's Agent to conduct a
credit check which includes, but is not limited to obtaining a
credit report and interviewing applicant references and/or previous
landlords. The applicant hereby consents to the credit check
process and authorizes any individual listed in this application to
speak with Owner/Owner's Agent regarding applicant's resent or
previous credit performance. Applicant further releases any and all
individuals who provide information to Owner/Owner's Agent from any
and all claims which applicant may have resulting from information
provided to Owner/Owner's Agent. The applicant also authorizes
release of information based upon reliance upon either photocopies
or facsimiles of this authorization.
Date submitted:
By selecting the following checkbox and submitting this application I agree to the above credit check
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