Cosigner Information

Applicant Information
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Special Code (if applicable)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date

MonthDayYear
School attending during your residency here

University of OregonLane Community CollegeOther
If "other," please specify
Where did you hear about us?

Print AdvertisementGoogle SearchFacebookFriendFamilyOther
if "other," please specify

Character References
INCLUDE 3 ADULTS, WHO ARE NOT RELATED TO APPLICANT, WHO ARE NOT PEERS, AND WHO HAVE KNOWN APPLICANT WELL FOR THE PAST 2 YEARS.
Reference 1

First NameLast Name
Title
Relationship to Applicant
E-mail
Phone Number

Area CodePhone Number
Reference 2

First NameLast Name
Title
Relationship to Applicant
E-mail
Phone Number

Area CodePhone Number
Reference 3

First NameLast Name
Title
Relationship to Applicant
E-mail
Phone Number

Area CodePhone Number

Brief Written Statement
To complete your application, please write a brief statement (1 paragraph to 1 page) describing why you believe you will be a good fit as a resident of The Collegian. You may include descriptions of your commitment to academic success, experiences which have taught you to be a good neighbor, and particulars about your lifestyle which are consistent with The Collegian's Code of Conduct
Statement

Authorization
I believe that the statements I have made are true and correct. I hereby authorize verification of information I provided and communication with any and all names listed on this application. I understand that any discrepancy or lack of information may result in the rejection of this application. I understand that this is an application for a residence and does not constitute a rental or lease agreement in whole or part.
Name

First NameLast Name
Date

MonthDayYear
Should be Empty:

Applicant Information