New Paltz Hostel Student Housing Request All utilities included, gas, electric, heat, water, interne...

Name

First NameLast Name

First Name

Last Name

Gender

Birthday (mm/dd/yyyy)

Cell Phone Number

Area CodePhone Number

EMAIL ADDRESS

E-mail

Current Address

Street Address

Street Address Line 2

CityState

Postal / Zip CodeCountry

ADDRESS

CITY

STATE

ZIP CODE

The New Paltz Hostel has zero tolerance towards illegal drugs and is in a ************** DRUG FREE SCHOOL ZONE ******************** Drug-Free living environment. The New Paltz Hostel is strongly committed to providing a safe, healthy, and productive living environment for all students. The Hostel recognizes that drug abuse affects our society at all economic levels and ages. Drug abuse in the Hostel creates obvious problems. Students who take drugs are less productive, are absent more frequently, are more likely to be involved in accidents, and tend to have negative encounters with other residents. Drug abuse causes other serious problems: it increases health care costs, takes extra supervisor and managerial time, increases incidents of criminal activity, and has an adverse effect on our public image. Drug Abuse Policy Possession, sale, non-prescriptive use, distribution, dispensation, manufacture, or transfer of any controlled substance is prohibited. Controlled substances can include heroin, codeine, morphine, cocaine, "crack" or other cocaine derivative, amphetamines, barbiturates, LSD, marijuana, or mescaline. Violation of this policy will result in disciplinary action, which may include immediate termination of lease. Where appropriate, the violator may face arrest and criminal prosecution.

I am aware that there is a "NO" Smoking Policy within the New Paltz Hostel and smoking is only permitted in the back of the property

I am aware that there is a no alcohol policy at the Hostel

Have you ever applied for housing or work at the New Paltz Hostel before? If so when?

How did you find out about New Paltz Hostel? Referred by anyone? if so who

Room type

I understand if my application is accepted I will have to submit a security deposit of 1 month's rent.

Move in date:

Date

Move out date (any changes need to be submitted 30 days before new move out date)

Date

I understand that I need to pay a months room security deposit, that I will receive back after the room, refrigerator, and cabinet is vacated, cleaned and left in the same condition I moved in.

Where are you living now? Be very specific.

Please include current landlord and phone and address

How much are you paying rent?

Why are you moving?

Who is going to be legally responsible for your monthly rental payments and the lease?

What is the source of income to pay the rent each month? Please be detailed.

Why do you want to move to the Hostel?

Education: please check all that apply.

Are you attending SUNY New Paltz?

When will you graduate or transfer from SUNY New Paltz?

Date

Do you have a car?

Special Courses, Training, Experience, and/or Skills you may have.

Employment History: LIST PRESENT OR MOST RECENT FIRST!

Name and address of employer #1.

Starting pay rate

Ending pay rate

Date hired

Date

Date departed or leave blank if still working there

Date

Phone Number

Supervisor Name

Position held and duties performed

Reason for leaving

Character References (include at least 1 employer:

My Products

Background Check$50.00

To keep the home safe, we run background checks on all potential residents.

Total $0.00

Credit Card

State any additional information you feel may be helpful to us in considering your application.

I understand that if a nationwide background check reveals anything not disclosed above my application will be automatically disqualified.

I understand this is a shared environment. By checking this box, I agree to keep the common areas clean and sanitary. We do not permit pets.

Guests are allowed in the Hostel but must leave by 10:00PM & 2 overnight guests are permitted per month for free, each additional overnight guest would be $30 per night - Staff must be notified of all overnight guests.

Emergency contact (example: parent or guardian).

Namerelationship

Phone Number

Area CodePhone Number

During your stay at the Hostel how will you be spending your time?

Other

By typing my name below I give permission to verify all information and I certify that the information provided above is true and correct. I authorize a nationwide background and credit check. My rent payment history will be reported to NTN