Full Name:                
		 Birth Date:               
		 Current Street Address:   
		 Current City/State/ZIP:   
		 Previous Street Address:  
		 Previous CIty/State/ZIP:  
		
		 Cellular Phone #:         
		 Home Phone #:             
		 Email Address:            
		 Student: YES/NO           
		 Graduate/Undergraduate:   
		 Expected Graduation Date: 
		 Preferred Move In Date:   
		 Employer:                 
		 Employer Phone #:         
		 Drivers License #/State:  
		
		 Social Security #:        
		 Name & Phone # of Current Landlord: 
		 Name of Parent/Guardian:  
		 Parent/Guardian Street Address: 
		 Parent/Guardian City/State/ZIP: 
		 Parent/Guardian Phone #:  
		 List any References with Phone #:   
		 

		 PERSONAL PREFERENCES & ATTRIBUTES
		 

		 Studio, 2, or 4 Bedroom:  
		 Smoker - Yes/No:          
		 Drinker - Yes/No:         
		 Neat & Tidy - Yes/No:     
		 Quiet - Yes/No:           
		 

		 ROOMMATE PREFERENCES
		 

		 Smoker - Yes/No:          
		 Drinker - Yes/No:         
		 Neat & Tidy - Yes/No:     
		 Quiet - Yes/No:           
		 Male, Female, or Either:  
		 Name of Roommates You Would Like to Live With: 
		         
		 How Did You Hear About University Suites?:     
		         
		 Comments: