Background Check Information

Only the student must fill out this form. Please fill out all information accurately.

Student's Legal First Name*
Student's Legal Middle Name*
(If none, put N/A)
Student's Legal Last Name*
Date of Birth*

(mm/dd/yyyy. Example: March 12, 1996 = 03/12/1996)
Social Security Number*
International YAs, just enter 000-00-0000
Passport Number*
Passport Country*
Country
Mobile Phone*
Student Email*
Enter Email Confirm Email
Current Street Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date of Residency*
Ending Date of Residency*
Previous Street Address (if any)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date of Residency
Ending Date of Residency
Have you ever been evicted?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
Do you have any criminal charges pending, awaiting disposition or looming in any way?*
- Yes
- No
Acknowledgment. You declare that all your statements in this Application are true and complete and you agree to be screened after payment of the application fee(s). You authorize us to verify same through any means. If you fail to answer any question or give false information, we may reject the application, retain all application fees and deposits as liquidated damages for our time and expense, and terminate your right of occupancy. Giving false information is a serious criminal offense. In lawsuits relating to the application or Lease Contract, the prevailing party may recover all attorney's fees and litigation costs from the losing party. We may at any time furnish information to consumer reporting agencies and other rental housing owners regarding your performance of your legal obligations, including both favorable and unfavorable information about your compliance with the Lease Contract, the rules, and financial obligations.
Phone
This field is for validation purposes and should be left unchanged.