Apartment Application Form for University of Rochester Graduate and Family Housing

Last Name *

First Name *

MI

University ID (if known) *

Gender *

Male

Female

Other

Marital Status *

Married

Single

CURRENT MAILING ADDRESS

Street Address *

City *

State

Country *

Zip Code *

Cellphone Number *

Fax Number

Email Address *

CITIZENSHIP INFORMATION - HOME ADDRESS

Street Address *

City *

State

Country *

Zip Code *

University Affiliation *

College

Status *

* If Postdoctoral, Prof. Trainee, or Fellow selected, provide Title and Appointment.

Title:

Appointment:

Have you previously lived in University Housing? *

If yes, where?

Earliest Desired Occupancy Date *

Latest Desired Occupancy Date *

List the names of family members or the roommate who will live with you in University Housing

Spouse or Partner's Name

Date of birth +

Gender

Male

Female

Other

Children's Names, Ages & gender

Child's name

Date of birth +

Gender

Male

Female

Other

Child's name

Date of birth +

Gender

Male

Female

Other

Child's name

Date of birth +

Gender

Male

Female

Other

Identified Roommate (IRM) (if known)

Indicate all preferences by selecting all the interested

CODE KEY: BH = Bath(s); F = Furnished; UF = Unfurnished; GHS = Goler House; UPK = University Park; WPK = Whipple Park

S = Single Occupancy

SR = Single with Identified Roommate

C = Couples

GHS 1 BR (F)

GHS 1 BR (UF)

UPK Studio (UF)

UPK 1 BR (UF)

FA = Family (1-2 Children)

UPK 2 BR (UF)

WPK 2 BR Town House (UF)

WPK 2 BR Walk-up (UF)

WPK 2 BR Walk-down (UF)

FB = Family (3-4 children or 2 children of opposite gender, one or both over 8 years old)

WPK 3 BR Town House (UF)

Are there any special considerations for housing placement?

I have read and understand responsibility for policies in Graduate Housing Guide and Living Guide. *

Yes