APPLICATION – Bearcat Den

Name*

First Last

Gender Identity*

Female
Male

Home Address*

Street Address Address Line 2 City State ZIP

Phone*

Email*

University/College Attended*

Year*

Academic Housing Request For*

Myself
My Family

Starting Semester*

Starting Semester Year*

I require ADA accommodations or equipment for the mobility and/or hearing-impaired.*

Yes
No

Please specify accommodation(s) requested, special physical needs, medical conditions or prescriptions, or other pertinent information which you would like to disclose and make Residence Life staff aware of in order to better serve you.*

EMERGENCY CONTACT INFORMATION

The person you list below will be contacted in the event you should become injured or incapacitated.

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP

Day Number*

Evening Number*

Cell Phone*

Email*

SECONDARY EMERGENCY CONTACT INFORMATION

The person you list below will be contacted in the event you should become injured or incapacitated.

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP

Day Number*

Evening Number*

Cell Phone*

Email*

SINGLE STUDENT HOUSING OPTIONS

An application fee of $50 must be obtained in order to be processed and reserve a space in one of your preferred choices below. The deposit is your personal responsibility and cannot be paid via financial aid award. Please indicate your housing assignment preferences below. Academic Housing, LLC works to honor preferences as best that we can, however, assignment decisions are based upon availability and occupancy demands at the time of application/contract processing.

FIRST CHOICE Apartments/Townhouses*

4 Bedroom Apt. / 4 person / private bedroom/private bath – 412 Summerfield
4 Bedroom Apt./4 person/private bedroom/private bath – 410 Summerfield – No Balcony
4 Bedroom Townhouse/4person/private bedroom/private bath with Balcony

SECOND CHOICE Apartments/Townhouses*

4 Bedroom Apt. / 4 person / private bedroom/private bath – 412 Summerfield
4 Bedroom Apt./4 person/private bedroom/private bath – 410 Summerfield – No Balcony
4 Bedroom Townhouse/4person/private bedroom/private bath with Balcony

THIRD CHOICE Apartments/Townhouses*

4 Bedroom Apt. / 4 person / private bedroom/private bath – 412 Summerfield
4 Bedroom Apt./4 person/private bedroom/private bath – 410 Summerfield – No Balcony
4 Bedroom Townhouse/4person/private bedroom/private bath with Balcony

UTILITY DISCLOSURE

Included in monthly rent is trash service, internet service and basic cable and basic furnishings. Each person will be granted a $45 per bed/ per month Conservation Cap for electricity and $25 for water/sewer. In the event of usage in excess of these conservation caps, the utility will be billed to the occupants.

ROOMATE REQUEST

Those applicants requesting roommates are encouraged to submit their application as soon as possible. All requested roommates must have their applications submitted before being assigned.

Please indicate your FIRST apartment preferences below.*

Please check website for current rates for the academic year.

4 Bedroom

Please indicate your SECOND apartment preferences below.*

Please check website for current rates for the academic year.

4 Bedroom

List below requested roommates. Criminal background checks and credit checks may be conducted on all potential adult applicants (at Student’s additional expense).

Roommate 1*

First Last

Roommate 1 Birthdate*

Roommate 2

First Last

Roommate 2 Birthdate

Roommate 3

First Last

Roommate 3 Birthdate

ACCEPTANCE

By signing this form, I certify that all information submitted on this application/contract is true and accurate. I hereby also certify that I understand that the document that I am signing is legally binding for the specified contract terms as outlined in the terms and conditions for the associated Academic Year. (Please note that by typing your name in the signature sections of this document that you agree that your electronic signature is the legal equivalent of your manual signature, thereby making you legally bound by this agreement's terms and conditions).

Applicant's Signature*

First Last

Date*

Signature of Parent/Guardian

ONLY required if applicant is under 18 years of age at time of application/contract

First Last

Date*

Referral

Comments

This field is for validation purposes and should be left unchanged.