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Off Campus Housing Form
Please complete this form if you will be living off-campus (non-residence halls) for the 2011-12 academic year.

Required Fields in Bold
Student-Athlete Name
 
Student ID Number
 
Sport
 
 
Off-Campus Address
Address (Street, Apt., City, State, Zip)
 
Land Line Phone Number
 
 
Housing Information
Type of Housing
 
Apartment/Townhouse
House
Faternity/Sorority
Other
 
Do you live with a parent or legal guardian?
 
Yes
No
Owner/Property Manager/Landlord Name
 
Owner/Property Manager/Landlord Phone Number
 
How did you find this residence?
 
Please list your roommates (even if not student-athletes)
 
What are YOUR mothly rent payments?
 
What is the TOTAL monthly rent for ALL residents?
 
If your monthly payment is not equal to that of your roommate(s), please explain why
 
Did you pay a housing deposit?
 
Yes
No
If yes, how much was the deposit?
 
Who paid the deposit?
 
Who pays your monthly rent?
 
 
Written Statement
By checking the below box, I confirm that I am paying the going rate for this residence and have not received any extra benefits or special arrangements (e.g., reduced/free housing, use of furniture, appliances etc.). If my housing information changes, I will notify the Compliance Office immediately.
 
Student-Athlete Confirmation of Understanding
I cannot confirm because I still have questions regarding the above information.
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