LHU Housing Rental Application

LHU Housing Rental Application

R&R Real Estate | LHUHousing.com | Lock Haven, PA | Phone: 570-660-1379 | Email: russelmoldovan@gmail.com. Each adult applicant must complete their own application. Background screening is completed online — you will be sent a secure link and enter your information directly into the screening provider's site. Your Social Security number is never collected on this application. Primary method: Zillow application ($35 paid by the applicant to Zillow; one payment is reusable for 30 days). Alternate method: a TransUnion SmartMove link emailed to you (approx. $39–$49).
1. Applicant Information
Application Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Property Applied For
Property Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
First Name
Middle Initial
Last Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Driver's License No.
State of Issue
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
2. Student Information
Are you currently a university student?
School name
Year in school (e.g. freshman, sophomore, junior, senior, graduate)
Expected graduation (MM/YYYY)
Advisor name
Advisor phone or email
3. Residence History (last TWO addresses)
A. Current Address - Street Address
A. Current Address - City
A. Current Address - State
A. Current Address - ZIP Code
A. Current Address - Monthly Rent
A. Current Address - From (MM/YYYY)
A. Current Address - To (MM/YYYY or Present)
A. Current Address - Own / Rent / Other

Other
A. Current Address - Reason for leaving
A. Current Address - Landlord / Manager Name
A. Current Address - Landlord Phone
Please enter a valid phone number.Format: (000) 000-0000.
B. Previous Address - Street Address
B. Previous Address - City
B. Previous Address - State
B. Previous Address - ZIP Code
B. Previous Address - From (MM/YYYY)
B. Previous Address - To (MM/YYYY)
B. Previous Address - Monthly Rent
B. Previous Address - Own / Rent / Other

Other
B. Previous Address - Reason for leaving
B. Previous Address - Landlord / Manager Name
B. Previous Address - Landlord Phone
Please enter a valid phone number.Format: (000) 000-0000.
4. Employment & Income
Employer Name
Position / Title
Supervisor Name

First NameMiddle NameLast Name
Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employed From (MM/YYYY)
Monthly Gross Income
Co-Applicant Employer Name
Co-Applicant Position / Title
Co-Applicant Supervisor Name

First NameMiddle NameLast Name
Co-Applicant Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Co-Applicant Employed From (MM/YYYY)
Co-Applicant Monthly Gross Income
Other Sources of Income (source and monthly amount)
5. All Occupants (every person who will live in the home)
Occupant 1 Name

First NameMiddle NameLast Name
Occupant 1 Age
Occupant 1 Relationship to Applicant
Occupant 2 Name

First NameMiddle NameLast Name
Occupant 2 Age
Occupant 2 Relationship to Applicant
Occupant 3 Name

First NameMiddle NameLast Name
Occupant 3 Age
Occupant 3 Relationship to Applicant
Occupant 4 Name

First NameMiddle NameLast Name
Occupant 4 Age
Occupant 4 Relationship to Applicant
6. Pets
Do you have pets?
If yes, how many pets?
Pet details (type, breed, weight)
7. Background Questions (answered by each adult applicant)
You may attach an additional page to provide context for any conviction. Each application is reviewed individually considering the nature, severity, and recency of any offense.
Have you ever been convicted of a crime?
If yes, provide details of each conviction, including offense, date, and county.
Additional context for any conviction
Optional additional page for conviction context (do not include SSNs)

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Have you ever been evicted, or has an eviction ever been filed against you?
If yes, provide details and date
Have you ever declared bankruptcy?
If yes, provide details and date
8. Emergency Contact
Emergency Contact Name

First NameLast Name
Emergency Contact Relationship
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
9. Authorization & Consent
I authorize R&R Real Estate / LHUHousing.com to verify all statements and information in this application, including: rental history with current and previous landlords; employment and income with employers/supervisors listed above; and public court and criminal records and other publicly available information relevant to evaluating this application. I understand that the formal credit/criminal/eviction screening is completed separately through a secure online link (Zillow or TransUnion SmartMove), where I will provide my Social Security number directly to the screening provider and consent to the report. I certify that all statements in this application are true, correct, and complete. I understand that any false or incomplete information may result in rejection of this application or termination of a lease agreement.
I have read and agree to the Authorization & Consent above.
Applicant Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Printed Name

First NameMiddle NameLast Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
It is against the law to discriminate in the rental of a dwelling based on race, color, religion, sex, handicap, familial status, or national origin. State and local laws may protect additional classes. We apply the same application and screening standards to every applicant.
Should be Empty:

LHU Housing Rental Application

1. Applicant Information

2. Student Information

3. Residence History (last TWO addresses)

4. Employment & Income

5. All Occupants (every person who will live in the home)

6. Pets

7. Background Questions (answered by each adult applicant)

8. Emergency Contact

9. Authorization & Consent