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Applicant Name: * Student Housing Rental Application Please, enter the text shown in the image into the field below. captcha code reload Please complete the form below completely. A $500.00 security deposit is required upon approval of your application.* Personal Information Sex: * SS #: * (ex: 111-11-1111) Date of Birth: * Address: * City: * State: * Zip: * Semester: * Year: * Fall Spring M F Major: Do You Smoke: * Parents/Guardian/Guarantor Name: * Address: * City: * State: * Zip: * Emergency Contact Name: * Phone: * (ex: 123-123-1234) Address: * City: * State: * Zip: * Phone: * (ex: 123-123-1234) Vehicle Information Make & Model: Year: Color: License Number: State: Owner: I agree by checking this box the information is complete and correct. I understand that if I do not move in my security deposit is non-refundable. Additional Comments: Phone:* (ex: 123-123-1234) Email: *

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