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APPLICATION

Check box that applies:
*Required
Summer 2010
Academic year 2010 - 2011
APPLICANT
Ms. Mr. Name:
Nickname:
Current Address:
City / Province:
State:
Zip code:
E-mail:
*Required
Phone:
Cell Phone:
Birth Date:
Driver's License State and #:
High School Attended:
School Attending During Collegian Residency: UO
Lane CC Both
Class Standing During 1st Quarter of Collegian Residency:
Major:
REFERRAL SOURCE
Where did you hear about us?:
*Required
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:
Home Phone:
Work Phone:
Cell Phone:
Fax:
   
Co-signer Name: 2.
Address:
If different
City / Province:
State:
Zip code:
E-mail:
Relationship to applicant:
Home Phone:
Work Phone:
Cell Phone:
Fax:
PAYMENT
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:
  • September 6, 2010
  • December 13, 2010
  • March 7, 2011
    		•
    I understand that The Collegian rates listed
    are due per quarter     		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
    See if you qualify!
    Applying for financial aid? Yes
    No
    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
    Any
    StudioPlex: North
    South
    North Corner
    South Corner
    Any
    If StudioPlex double, Roommate's name:
    (LEAVE BLANK IF NONE)
    Smoking Frequency Never
    Occassionally
    Regularly
    PARKING GARAGE
    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:
    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.

    Ms. Mrs. Mr. Reference Name 1:
    Title:
    Relationship to applicant:
    Day Phone:
    Evening Phone:
    E-mail:
    Best time of day to reach:

    Current or recent teacher, counselor, coach, etc.

    Ms. Mrs. Mr. 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

    Ms. Mrs. Mr. Reference Name 3:
    Title:
    Relationship to applicant:
    Day Phone:
    Evening Phone:
    E-mail:
    Best time of day to reach:

    RA

    Ms. Mr. 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: 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:

    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 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
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    Please verify the letters and numbers shown at left in the box above.

     

    We are located on the southwest Corner of 18th and Alder in Eugene, close to campus and the University shopping district. The main University library, the Knight Library, is just a few blocks away. For those coming to town without cars, we are also right on the public bus line.

    1810 Alder St.
    Eugene OR 97401
    (541) 343-1255




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