Name:

SSN/ID#:

E-Mail Address:
(Correspondence about Apartment offers will only be sent via e-mail.)

Class Status: -Freshman -Sophomore -Junior -Senior

-Graduate

Phone #:

Address:

City: State: Zip:

Spouse or Partner's Name:

Select All the Following that Apply: -Parent -Married/Partnership

-NonTraditional Student (age 23 and older)

Number of Children & Ages

Requested Occupancy Dates (MM-DD-YYYY):

From: To:

Apartment Type Desired:

- One Bedroom Unfurnished - ESU Family Housing Apartments

- Two Bedroom Unfurnished - ESU Family Housing Apartments

NOTE: DO NOT SEND DEPOSIT UNTIL APARTMENT IS OFFERED

Filling out this request DOES NOT guarantee an apartment will be offered