Venango Student Housing Application

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I am a

Returning tenantNew tenant

Personal Information

*First name

*Last name

Sex

MaleFemale

Permanent Address

*Street address

*City

State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zip

Local Address

*Street address

*City

State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zip

Date of birth*

Marital status

Single Married

*Home phone

*Cell phone

*Email

Parent/Guardian Information

*Parent/Guardian name

Parent/Guardian Address

*Street

*City

State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zip

*Relationship

*Home phone

*Cell phone

Enrollment Information

University enrollment status

Full time (12+ credits)Part time (0-11 credits)

Beginning semester

Spring 2022Fall 2022Spring 2023Fall 2023

*Major

*High school

Lease preference

Academic yearExtended academic year

I am interested in the following Living Learning Communities

Medical ImagingNursing

Roommate preferences

*The undersigned hereby offers to rent premises on terms and conditions described herein and upon acceptance of this appplication agrees to sign a rental or leasing agreement and to pay all sums due, including required fees or deposits. Application and Service fees are non-refundable. The undersigned warrants the above information is true and correct and authorizes verifaction of such

*Date

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