Apply Here
* Required
First Name
*
Your answer
Last Name
*
Your answer
Gender
*
Male
Female
Email
*
Your answer
Phone Number
*
Your answer
Your Birthday
*
MM-DD-YYYY
Your answer
Social Security Number
*
xxx-xx-xxxx
Your answer
Home / Permanent street address
*
Your answer
City, State, Zipcode
*
Your answer
Please enter your last 2 addresses, if different from permanent
Your answer
Please enter your previous landlord's contact information name and phone number
type "no previous landlord" if this is your first time renting
Your answer
Current Employer
*
type "not employeed" if you're not currently employeed
Your answer
Employer phone number
Your answer
Have You Ever Filed a Petition For Bankruptcy?
*
Yes
No
Have You Ever Been Evicted From Any Tenancy Or Had An Eviction Notice Served On You?
*
Yes
No
Have You Ever Willfully And Intentionally Refused To Pay Rent When Due?
*
Yes
No
Have You Ever Been Convicted of a Misdeamenor or a Felony Other Than a Traffic Or Parking Violation?
*
Yes
No
Are You A Current Illegal Abuser or Addict of A Controlled Substance?
*
Yes
No
Have You Ever Been Convicted Of the Illegal Manufacture or Distribution Of a Controlled Substance?
*
Yes
No
Which Type of Housing Are you Looking For?
*
$975 Per Semester Shared Room
$1395 Per Semester Private Room
$455 Summer Contract Shared Room
$755 Summer Contract Private Room
What semester are you planning on staying?
*
Spring
Summer
Fall
Name of Requested Roommate(s)
Your answer
Other Requests (ex: upstairs, basement etc...)
Your answer
How Did You Find Out About Stonebrook?
*
Student Housing Guide
Board at SUU / Institute
Friend
Driving
Internet
Flyer
Phone Book
Reffered by SUU
Other:
By ELECTRONICALLY SIGNING and SUBMITTING This Form, I Declare That The Foregoing Is True And Correct, And Authorize Its Verification.
*
type your full name as a signature
Your answer
Submit
Page 1 of 1
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy