Read Microsoft Word - TC APPLICATION 2011-2012.doc text version

TELEGRAPHCOMMONS ApplicationforResidency

st

Applyingfor:Summer2011Fall2011Spring2012

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RoomType:1 Choice:SingleDoubleTriple;2 Choice:SingleDoubleTriple FloorPreference:AllGirlsCoEd

STUDENTAPPLICANTINFORMATION

Name:_____________________________________________________________DateofBirth_____/_____/_____

Last First Middle

Gender:MaleFemale(ForRoommateMatchingPurposes) MailingAddress:______________________________________________________________________________________

StreetCity,State,ZipCode MainPhone AlternatePhone Country(ifnotU.S.A.)

Telephone#_______________________________________________EMailAddress:_________________________________ SchoolAttending:__________________________________________Semester/Yearstarted_________________________ StudentID#__________________________DriversLicense#______________________orSSN_______________________ INCASEOFEMERGENCY,NOTIFY:Name:____________________________________ Relationship:_____________________ Phone#()____________________Address:______________________________________________________________ Street City,State,ZipCode PARENT/GUARANTORINFORMATION NameofParent/Guarantor:_______________________________________________________________________

Last Street First Middle

Address:____________________________________________________________________________________________

City,State,Zip

RelationshiptoApplicant:______________________Phone#_____________________EMail:_____________________ HomePhone#()_______________________ PROPERTYSPECIFICUNIT/COSTINFORMATION(ForOfficeUseOnly) Unit/RoomTypeAppliedfor:________________________________ Deposit:$____________OtherFees:$____________

Thespacewillnotbeconfirmeduntiltheacceptanceoftherentalagreement,housingpaymentandsecuritydeposit."Acceptance"meansyourHousing Payment&Depositare"cashed"andallformscompletedandexecutedbyStudent,Parents&TelegraphCommons. ____________________________________________________________ Oncecompleted,pleasefaxto ApplicantSignature Date 4153946095,oremailto [email protected] ____________________________________________________________ GuarantorSignature Date

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