Personal information:
Todays Date: (mm/dd/yyyy)
Name:
Phone number: (xxx) xxx-xxxx
E-mail:
Status:
Select One
Undergrad
Grad
Gender:
Select One
Male
Female
Address:
Street:
Apt. #:
City:
Zip Code:
House or apartment information:
Type of Housing:
Select One
House
Apartment
Number of bedrooms:
Select One
2
3
4
5
More than 5
Number of bathrooms:
Select One
1
2
3
Distance from campus:
# of Roommates Needed:
Rent per person: $
Deposit: $
Utilities paid:
Select One
Evenly by roommates
Portion by roommates
Landlord
Both tenants and Landlord
Cooking Facilities:
Select One
Yes
No
Furnished living area:
Select One
Yes
No
Pets:
Select One
Yes
No
Negotiable
Disability Access:
Select One
Yes
No
Off-street parking:
Select One
Yes
No
Washer Dryer:
Select One
Yes
No
Air conditioning:
Select One
Yes
No
Date available: (mm/dd/yy)
Lease dates: to
Roommate Preferences:
Sex:
Select One
Male
Female
Either
Smoker:
Select One
Yes
No
No preference
Status:
Select One
Undergrad
Grad
Either
Additional Comments: