Backup-housing-APPLICTN

Contact Information:
Lisa White
Foundation Village Rental Coordinator
(570) 484-2994 (phone)
(570) 484-2774 (fax)
lisa.white@lhufoundation.org

Rental APPLICATION

Name

First Name

Last Name

Email Address

Cell Phone

Country

(###)

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Home Phone

Country

(###)

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Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Local Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Social Security Number

Student ID Number

Marital Status

Gender

Parent/Guardian Information

Name

First Name

Last Name

Relationship

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

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Cell Phone

(###)

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Work Phone

(###)

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General Information

College Enrollment

Current Year at LHU

Freshman

Sophomore

Junior

Senior

Graduate Student

Enrollment Status

Full Time

Part Time

Name of College

Intended Major

Name of High School

Employer Information

Employer Name

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone

(###)

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How Many Months/Years Employed

Monthly Salary

Banking Information

Name of Local Bank

Type of Account(s)

Unit and Roommate Preferences

Type of Unit Preferred

Type of Lease Requested (Physician Asst. graduate students need a 12 month lease)

Require a Handicapped Accessible Unit

Yes

Are You a Smoker

Names of Roommate Preferences (Optional)

Foundation Village is owned and managed by the LHU Foundation, DACC, 10 Susquehanna Ave., Lock Haven, PA 17745

foundation village

RENTAL INFORMATION

rental application

EVERGREEN COMMONS

FAIRVIEW SUITES

Rental APPLICATION