Rental Application Form - University of California, Santa Cruz

Reviewed 2/15
RENTAL APPLICATION
Applicant’s Last Name: ______________________________ First Name: __________________________________ M.I.:
_______
Social Security # or ITIN: _________________________ Date of Birth: ________________ Contact Phone:
___________________
Photo ID Type: ______________________ Number: ____________________ Issuing government: ___________________________
Date expires: ____________ Other ID:_______________________ E-mail Address: _______________________________________
1. Present Address: _______________________________ City: _________________________ State: ______ Zip Code: ________
Owner/Manager: _____________________________ Phone (Required): _______________________ Rent Amount: ________
From/To: ____________________________________ Reason for Leaving: _________________________________________
2. Previous Address: ______________________________ City: _________________________ State: ______ Zip Code: ________
Owner/Manager: _____________________________ Phone (Required): _______________________Rent Amount: ________
From/To: ____________________________________ Reason for Leaving: _________________________________________
3. If applicable, Current or Previous Campus Address: _______________________________________________________________
From/To: ___________________________ Rent Amount: _____________________ Campus Housing Office: (831) 459-2394
Housing/Residential-Life Office Phone: ___________________________ Student ID #: ________________________________
Have you turned in a UCSC Reference Release form to Campus Housing?
Yes No I will do it within 3 days
4. Proposed Occupants/Ages: (1) _______________________ (2) _______________________ (3) _________________________
(4) _______________________ (5) _______________________ (6) _________________________
5. Pets: _______________________________________________________________________ Smoker: Yes No
6. Present Occupation: _______________________________ Employer: ___________________ From/To: ____________________
Name of Supervisor: _____________________________ Phone: ______________________ City: _______________________
7. Previous Occupation: ______________________________ Employer: ___________________ From/To: ____________________
Name of Supervisor: _____________________________ Phone: ______________________ City: _______________________
8. Current Gross Income: $ ____________________________ Per: ________________________ Savings: ___________________
9. Financial Aid Award: $____________________________________ Per: ______________________________________________
10. Personal Reference: _____________________________________ Phone: ___________________________________________
11. Emergency Contact: _____________________________________ Phone:
___________________________________________
Relation:
_____________________________________
E-mail:
____________________________________
12. Vehicles: Make/Year/License #: (1) ___________________________________________________________________________
(2) ___________________________________________________________________________
13. Address of Proposed Rental: ________________________________________________________________________________
14. Proposed Move-in Date: ___________________________
I
Applicant represents that all the above statements are true and correct and hereby authorizes verification of the above items including,
but not limited to, the obtaining of a credit report.
Dated: ____________________________________________ Applicant signature: _______________________________________ _
NEVER send your Social Security
number through e-mail
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