Check box that applies (required) Summer 2011 Summer 2011 and AY 2011 - 2012 Academic year 2011 - 2012
Ms. Mr.
Name
Nickname
Current Address
City / Province
State
Zip code
Email (required)
Phone
Cell Phone
International Phone
Birth Date
Driver's License State and #
High School Attended
School Attending During Collegian Residency UO Lane CC
Class Standing During 1st Quarter of Collegian Residency ---FreshmanSophomoreJuniorSeniorGraduate
Major
Where did you hear about us? (required) ---Post CardSearch EngineFriendFacebookDrive-ByCraigslistASUO Housing OfficeAmerican English InstituteU of O AdministratorU of O Bulletin BoardHousing WebsiteOther
If FRIEND, who?
If OTHER, specify
First Co-signer Name: (required)
Address
Zip Code
E-Mail
Relationship to applicant
Home Phone
Work Phone
Fax
Second Co-signer Name:
Address if different
Send statements to Co-signer Resident Both
Payment option 3 Quarters pay by Check Pay in full (2% discount - Academic year only)
Summer Occupancy dates
Payments due:
I understand that The Collegian rates listed are due per quarter
I understand that the security deposit is due within 7 days of application approval
Academic Scholarship Applicant
Applying for financial aid? Yes No
Custom Studio North South North Corner South Corner Any
StudioPlex North South North Corner South Corner Any
If StudioPlex double, Roommate's name (LEAVE BLANK IF NONE)
Please type in this box your preferred style of room. Then by checking below indicate below which side of the building your prefer.
Smoking Frequency Never Occassionally Regularly
Reserved space in parking garage includes remote opener $350, Academic Quarter $150, Summer Quarter $50, Summer Month NO
Vehicle Make
Model
License plate # and state
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.
Ms. Mrs. Mr.
Reference Name 1
Title
Day Phone
Evening Phone
E-mail
Best time of day to reach
Reference Name 2
Reference Name 3
Reference Name 4
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 Apt. #
Landlord Phone
Landlord Fax
Previous/Current Dorm Name
Criminal history information:
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:
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
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 lifestyle 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)
Please verify the letters and numbers shown
