APPLICATION
*Required
APPLICANT
Name:
Nickname:
Current Address:
City
/ Province:
State:
Zip code:
E-mail:*Required
Phone:
Cell Phone:
Birth
Date:
Soc.
Sec. #:
Driver's License State and #:
High School Attended:
School Attending During
Collegian Residency:
Class Standing
During 1st Term of Collegian Residency:
Choose One
Freshman
Sophomore
Junior
Senior
Graduate
Major:
Referral
Source:
Choose One
Post card
Search engine
Friend
Drive-by
Craigslist
ASUO Housing Office
American English Institute
U of O administrator
U of O bulletin board
Housing website
Other
If FRIEND, who?
If OTHER,
specify:
CO-SIGNER(S)
Co-signer Name: *Required
1.
Address:
City
/ Province:
State:
Zip code:
E-mail:
Relationship to applicant:
SS# if co-signer is not
applicant's parent
Home
Phone:
Work Phone:
Cell Phone:
Fax:
Co-signer Name:
2.
Address:
City
/ Province:
State:
Zip code:
E-mail:
Relationship to applicant:
SS# if co-signer is not
applicant's parent
Home
Phone:
Work Phone:
Cell Phone:
Fax:
PAYMENT
Send
statements to:
Payment option:
Payments due:
Move-in day
1st day of each term
I understand
that The Collegian rates listed
Click here for rates
I understand that the security
deposit is due within 7 days of application approval
click here for security deposit information
Academic
Scholarship Applicant
PREFERRED
ROOM
Please type in this box your preferred style of room. Then by checking below indicate below which side of the building your prefer.*Required
Custom
Studio :
North
South North Corner South Corner
StudioPlex :
North South North Corner
South Corner
If StudioPlex double, Roommate's name:(LEAVE BLANK IF NONE)
Smoking Frequency
PARKING GARAGE
Reserved space
in parking garage
Vehicle
Make:
Model:
License plate # and state:
CHARACTER
REFERENCES
Include 3 adults, who
are not related to applicant, who are not peers, and who have known
applicant well for the past 2 years.*Required If current or former dorm resident, Resident Assistant (RA) must be included as well.
Current or recent teacher, counselor, coach, etc.
Reference Name 1:
Title:
Relationship to applicant:
Day Phone:
Evening
Phone:
E-mail:
Best time of day to reach:
Current or recent teacher, conuselor, coach, etc.
Reference Name 2:
Title:
Relationship to applicant:
Day Phone:
Evening Phone:
E-mail:
Best time of day to reach:
Adult who is unrelated to applicant
Reference Name 3:
Title:
Relationship to applicant:
Day Phone:
Evening
Phone:
E-mail:
Best time of day to reach:
RA
Reference Name 4:
Title:
Relationship to applicant:
Day Phone:
Evening
Phone:
E-mail:
Best time of day to reach:
RENTAL/CRIMINAL HISTORY
If this is your first time applying for a rental, please enter in the Previous/Current Landlord box: NA.
Previous/Current Landlord:*Required
Most Recent Landlord Address, City, State, Zip:
Landlord Phone:
Landlord Fax:
Previous/Current Dorm Name:
Have you ever (check if applicable) *Required
Been evicted or asked to move out?
Broken a rental agreement or lease contract?
Been or are currently delinquent to a previous landlord?
Had more than 3 late payments or 2 returned checks for rent in the most recent 12 month period?
Received deferred adjudication or conviction for a felony?
Received deferred adjudication or conviction for a sex-related offense?
Received deferred adjudication or conviction for a Class A Misdemeanor?
Been arrested?
None of the above applies to me.
If you checked any box(s), please explain:
BRIEF
WRITTEN STATEMENT
To complete your
application, please write a brief statement (1 paragraph to 1 page)
describing why you believe you will be a good fit as a resident of
The Collegian.
You may include descriptions of your commitment to academic
success, experiences which have taught you to be a good neighbor,
and particulars about your lifestyle which are consistent
with The Collegian's Code
of Conduct .
AUTHORIZATION
By typing applicant's name and date below, applicant represents that all of the above information is true and complete and authorizes verification of information through the performance of reference checks and criminal background checks. Applicant authorizes investigation of information as to character, general reputation, personal characteristics and mode of living of the applicant through contact with character references listed above. Applicant acknowledges that false information herein may constitute grounds for rejection of this application, termination of right of occupancy, and forfeit of deposit.
Name:*Required
Date:*Required
