Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Other Move In Date

This is a request, alternative move in dates can not always be accommodated.

MM

DD

YYYY

Cell Phone/Current Phone *

(###)

###

####

Permanent/Home Phone *

(###)

###

####

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Permanent/Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer's Phone

(###)

###

####

Former Residence #1 Office Phone

(###)

###

####

Former Residence #1 Office Fax

(###)

###

####

Date Resided #1

MM

DD

YYYY

Former Residence #2 Office Phone

(###)

###

####

Former Residence #2 Office Fax

(###)

###

####

Date Resided #2

MM

DD

YYYY

Have you ever been evicted from any tenancy? *

Yes

No

Have you ever been convicted of a crime? *

Yes

No

Do you smoke or drink? *

*SMOKING, ALCOHOL, AND UNATHORIZED OVERNIGHT GUESTS ARE NOT PERMITTED AT VENTANA STUDENT HOUSING; DO NOT SEEK TENANCY HERE IF YOU DO NOT INTEND TO ABIDE BY THESE RULES!

Yes

No

I hereby certify that: *

Check the boxes to acknowledge understanding.

1. I understand that I will be required to furnish Ventana with a Letter of Guaranty signed by a guarantor acceptable to Ventana management (PROVIDED FORM ATTACHED)

2. In the event that I sign a contract and pay initial monies upon signing this application, I understand that Ventana management may cancel my contract after investigating the information I and my guarantor have provided, return said monies and have no further obligation to me.

3. I understand that for safety and liability reasons, smoking and the consumption of alcohol by either residents or resident’s guests anywhere on the premises of Ventana is prohibited and I agree to abide by such rules.

4. I hereby submit with this application a non-refundable application fee of $50.00 and a $125 administrative signing fee.

5. I understand that I may elect to submit a security deposit of $200.00 in order to reserve my room. I understand that in the event that I decide not to enter a lease agreement with Ventana, this deposit will be non-refundable.

6. I understand that I am applying for a leasing contract and that I may elect to sell the contract under the terms of the rental agreement and with a $150 contract transfer fee.

7. We authorize VENTANA STUDENT HOUSING, its employees and agents to obtain confidential historical and financial information regarding us, our characters and credit worthiness from any person or entity and request all persons and entities possessing such information to release it to Ventana Student Housing and do hereby waive any claims related to the release of such information.

Date *

MM

DD

YYYY