HOUSING APPLICATION FORM

Citizenship Information

*Citizenship Select... US Citizen Non-US Citizen

If you are a Non-US Citizen, the following information is required.

Country of Citizenship
Visa Type
Visa Expiration Date

Identity Information

*First Name
Middle Initial/Other Name
*Last Name
*Gender Select... Male Female
*Date of Birth (MM/DD/YY)

Permanent Address Information

*Permanent Address
*City
*State/Provence
*Zip/Postal Code

Local Address Information

*Local Address
*City
*State Select...AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutWashington D.C.DelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming
*Zip / Postal Code

Contact Information

*Permanent Phone
*Local Phone
*Cell Phone
*Email
*Contact Preference Select... Permanent Phone Local Phone Cell Phone Email

Additional Information

How Did You Hear About Us? Select... MyOwnApartment.com EDRTrust.com Property Website Web Search Friend Family My University Flyer Advertising Newspaper Other

Are You a Current Resident of Evergreen Commons? Select... Yes No

Room Information

*Select Room Type Select ...2 Bedroom / 1 Bathroom ( $680/Monthly )4 Bedroom / 2 Bathroom ( $555/Monthly )


*Select Lease Term Select ...[Full Year] August 23 2012 - July 31 2013[Academic Year] August 23 2012 - May 24 2013[Fall] August 23 2012 - December 14 2012[Spring] January 1 2012 - May 18 2012

Additional Information

*Anticipated Move-In Date (mm/dd/yyyy) Roommate Preferences Names
1.

2.

3.

First Name
Last Name
Relationship

Home Address
City
State Select...AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutWashington D.C.DelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Zip / Postal Code
Home Phone
Work Phone

*College Enrollment Select... Yes - Full Time Yes - Part Time No
*Name of College / University
*Year/Status In School Select... Incoming Freshman Freshman Sophomore Junior Senior Graduate Student Faculty Staff
*Intended Major

*Name of High School
*High School Graduation Date
*Name of Local Bank
*Type of Accounts Please Select... Checking Only Savings Only Both Checking and Savings

Employer Name
Address
City
State/Province Select...AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutWashington D.C.DelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming
Zip/Postal Code
Phone

How Long Employed
Monthly Salary

Fees

$25 application fee

$150 service fee

Both the application and the service fee are NON-REFUNDABLE.

Credit Card Information

Following the submission of your application, you will receive a confirmation email with an application identification number. At your convenience, please call the sales office at (570) 893-1833. You will be asked for your credit card information to complete your application.

 

NOTE: No one from our property will call you to request this information. Do not disclose this information to anyone who would contact you claiming to be our representative.

We do not transmit and/or store credit card information.

 

*Please enter the word pictured to the left as anti-spam protection.