REFERRAL HOUSING QUESTIONAIRE Questionaires received within 30 days of requested move-in dates may result in being placed on a waiting list until housing accommodations are available. 1. Information About You
First Name: Last Name: S.S.N:
Address: City: State: Zip:
Phone (day): (evening): (cell): Email:
Birth date: / / Drivers Lic.#:
CHARACTER REFERENCES (Other than co-signer or emergency contact)
1. Phone: Email:
2. Phone: Email:
CONTACT IN CASE OF EMERGENCY:
Name: Phone: Email:
2. Co-Signer Information (Information on a co-signer is optional, but may assist us in recommending appropriate housing options. Please complete this section if you feel that you do not have a sufficient credit history and varifiable income.)
First Name: Last Name:
S.S.N: Relationship to student:
Address: City: State: Zip:
Phone (day): (evening): (cell): Drivers Lic.#
Birth date: / / Email:
Spouse First Name: Last Name: S.S.N:
Birth date: (month) (day) (year) Email:
Landlord/Mortgage Co. Name: How long lived there?
Co-Signer Employer: Yearly Income:
Employer Phone: Date of Hire: (month) (year)
Spouse Employer: Yearly Income:
Employer Phone: Date of Hire: (month) (year)
THE CO-SIGNER (IF REQUIRED) WILL SIGN THE LEASE AND BE RESPONSIBLE FOR ANY OUTSTANDING CHARGES (INCLUDING RENT) IF THE STUDENT IS UNABLE TO PAY
3. Information About Your Housing Preferences
City: School:
Start Date: Other:
School Rep.: Desired Move-In Date:
Number of people relocating and living with you: Age of Children:
Number of bedrooms desired: Budget for your monthly rent $
Have you ever been evicted?
Explain:
Have you had credit problems?
Explain:
Have you ever been arrested?
Explain:
Will you have
an automobile?
Do you need
public transportation?
Are you interested
in car pooling?

Do you have special requests or housing needs?
Explain:
Will you be bringing any pets?
Weight
&Type:

Housing Amenities Desired:
Will you need furniture?
Explain:
We cannot guarantee every request and preference can be matched to your satisfaction. We will do our best to accommodate you for a hassle free housing experience. We are an Equal Housing Provider.
AUTHORIZATION: I authorize CHS and my school to share pertinent information that may relate to my housing. Such information may include, but not be limited to: acceptance and financial aid approval, contact information, housing placement, etc.
PromoCode:
Your Initials:
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