930 E. 2nd St. Edmond, OK 73034 Office: 405.513.5166 Office use only: Date Application Received __________________ Application Fee _____ Yes ____ No _____ N/A Form of Payment: Money Order Check Cash Card Receipt: ___ Yes ___ No Check #: _____________ Completion: ___________________ Assigned Date: __________________ Assigned Room: __________________ [email protected] STUDENT HOUSING APPLICATION 2015-2016 Page 1 Note: Rooms are available on a first come, first serve basis based on receipt of application and fee. Returning students have first priority. Submitting this application does not guarantee applicant a room for the requested semester(s). Name of the college/university you are attending: Semester you plan to move in: Summer 2015 Fall 2015 Spring 2016 PERSONAL INFORMATION (PLEASE TYPE OR PRINT CLEARLY) Full legal Name: Last____________ First_____________ Middle___________ Other______________ E-mail:______________________________________________________________________________ Permanent address: ______________________ City: ______________ State: ________ Zip:_________ Phone: Home (___) _______________ Cell (___) ________________ Date of Birth: Month______ Day ______Year_______ Gender (mark one) :Male____ Female_____ Criminal History Have you ever been convicted of a felony? Have you ever been convicted of a misdemeanor in the past five years? Have you ever been convicted of a sexual offense crime? ____ Yes ____ Yes ____ Yes ____ No ____ No ____ No If answered “yes” to any of the questions above, please explain below. Please attach another sheet if necessary. *** Providing false information on your criminal history could result in the denial of your housing application.*** UNIT PREFERENCE Double Room 2 Queen Beds/2 Students per room $2625 / per semester, per student $5250 / two semesters, per student $1050 / Summer, per student Triple Room 3 Twin Beds / 3 Students per room $1950 / per semester, per student $3900 / two semesters, per student N/A Summer Each student is furnished a bed (see above), chest of drawers, wardrobe or closet, desk, chair, and night stand. Student is expected to furnish their own towels, linens, pillows, blankets, and personal items needed. ROOMMATE INFORMATION Page 2 Please assign: ____________________________________________as my roommate, if possible. I consider myself a: Night Owl (lights on after 11 p.m.) Early riser (lights on by 7 a.m.) What is your major: _________________________ Hobbies/Special Interests: __________________________ When do you study? Morning When you meet new people are you? Do you keep your room: Afternoon Late Nights Shy Outgoing Always picked up Usually picked up Seldom picked up Do you smoke? ____________ To maintain a wholesome environment for the enjoyment of all residents, the use of tobacco products, alcohol, and drugs are prohibited inside Central Plaza. Anything else you would like to share that would help us assign you a roommate? ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________ Do have any of the following conditions: Food allergies Asthma Diabetes Accommodations are available upon request to individuals with disabilities (must be documented). By signing below, I give Central Plaza permission to share my name and phone number with my potential roommate. (Please note that roommate changes may occur after information has been sent.) I further give permission to Central Plaza to conduct a criminal background check. Date: ______________________ Applicant’s Signature: ________________________ RELEASE OF LIABILITY I release Central Plaza, its employees and affiliates for incidents which may cause me physical, mental or monetary loss or damage, except in those incidents where Central Plaza can be shown negligent and directly responsible for the loss or damage. Central Plaza does not maintain insurance on any personal property of occupants. Date: ______________________ Applicant’s Signature: ________________________ Mail this completed and signed Student Housing Application, with Fee, to: Central Plaza Leasing Office 930 E. Second Street Edmond, OK 73034 A $100 nonrefundable Application Fee must accompany your application. The fee can be paid by mail, in person at the Leasing Office, or by phone. Your application and fee can also be placed in a drop box located outside the leasing office at Central Plaza. We accept cash, checks, credit/debit cards. Make checks payable to: Central Plaza Leasing Office phone: 405-513-5166 * A guarantor’s information and signature will be required on the Lease Agreement if student is less than 18 years old.