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First Name *
Last Name *
Gender *
Email *
Phone Number *
Your Birthday *
MM-DD-YYYY
Social Security Number *
xxx-xx-xxxx
Home / Permanent street address *
City, State, Zipcode *
Please enter your last 2 addresses, if different from permanent
Please enter your previous landlord's contact information name and phone number
type "no previous landlord" if this is your first time renting
Current Employer *
type "not employeed" if you're not currently employeed
Employer phone number
Have You Ever Filed a Petition For Bankruptcy? *
Have You Ever Been Evicted From Any Tenancy Or Had An Eviction Notice Served On You? *
Have You Ever Willfully And Intentionally Refused To Pay Rent When Due? *
Have You Ever Been Convicted of a Misdeamenor or a Felony Other Than a Traffic Or Parking Violation? *
Are You A Current Illegal Abuser or Addict of A Controlled Substance? *
Have You Ever Been Convicted Of the Illegal Manufacture or Distribution Of a Controlled Substance? *
Which Type of Housing Are you Looking For? *
What semester are you planning on staying? *
Name of Requested Roommate(s)
Other Requests (ex: upstairs, basement etc...)
How Did You Find Out About Stonebrook? *
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
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