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Juniors, Seniors, Graduate Students and Students Over 21 Unfurnished
Apartment Application and License Agreement
2014-2015 Academic Year
First name: _____________________ Last name: ____________________________ Middle Initial: ____
Nine digit Banner ID number: _______________________ WSU Access ID: ________________________
Permanent Street Address: ________________________________________ City: __________________
State: __________ Zip: ___________ Country: ______________________ Date of birth: _____________
Home phone: ____________________ Cell phone: _________________ E-mail address:_____________
Gender (circle one): MALE
FEMALE
Are you, or will you be over 21 as of August 23, 2014?
____Yes ___No
Student Information
Are you a United States Veteran?
____Yes ____No
Are you an English Language Institute student?
____Yes ____No
Are you a study abroad or exchange student coming here to the U.S to attend WSU? ____Yes ____No
Are you a Wayne State University Athlete?
____Yes____No
Are you married and will your spouse be living with you?
____Yes____No
Do you have children and will they be living with you?
____Yes____No
Are you a Law School or College of Medicine student?
__Law____Med
Do you require any special accommodations to reside in our apartments?
____Yes ____No
Please list below any reasonable accommodations you may require to live in WSU’s apartments. Please
note that doctor’s documentation may be asked to be provided by the Office of Housing and Residential
Life. _________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Apartment Style Preference
Please note: Juniors, Seniors, Faculty, Staff and students over 21 have the option of choosing an
unfurnished apartment in Chatsworth Tower, Deroy and University Tower. However, preference is
given to Graduate/Professional Students and students with families in Chatsworth Tower and Deroy.
Please rank at least three room options below:
University Tower Apartment
One Bedroom: ______
Two Bedroom: ______
Three Bedroom: _____
Chatsworth Towers
Efficiency: ______
One Bedroom: ______
Two Bedroom: ______
Deroy Apartment
Efficiency: ______
One Bedroom: ______
Two Bedroom: ______
Are you a current resident? ____Yes ____No
If so, please indicate current apartment building and number:________________________________
Apartment residents can sign up for an independent meal plan. For more information please contact
the Office of Housing and Residential Life.
Roommate Preference
If you know someone that you would like to be paired with, please indicate their name and 9 digit
banner ID number. Roommate requests must be mutual and have the correct banner IDs. Requested
roommates cannot be assigned to your apartment until they submit a completed license agreement. All
roommates shall be jointly and severally liable and responsible for the rental payments on their
apartment.
Roommates will not be assigned to you unless you preference one.
In the event you do not wish to have a roommate please leave blank.
Name: _____________________________________ 9 digit banner id #: _______________________
Name: _____________________________________ 9 digit banner id #: _______________________
Name: _____________________________________ 9 digit banner id #: _______________________
Name: _____________________________________ 9 digit banner id #: _______________________
Name: _____________________________________ 9 digit banner id #: _______________________
Behavioral and Criminal Background History
Wayne State University reserves the right to determine if it is in the best interest of the residential
community for an applicant to be permitted to live on campus based on their past behavior and/or
criminal activity. For the purpose of the following questions, please regard the term, “criminal behavior”
as any crime other than a traffic related violation or misdemeanor. In the event that you select YES for
either of the questions below, you must submit a detailed letter describing the facts of your conviction
to the Office of Housing and Residential Life before your application will be processed and an
assignment can be made. Please send your letter addressed to the Housing Coordinator, Wayne State
University Housing and Residential Life, 5221 Gullen #598, Detroit MI 48202.
Have you ever been convicted of, pled guilty or pled no contest to a criminal offense involving drugs
(other than alcohol) theft, violence (assault, assault and battery, criminal sexual conduct, stalking) arson
or threats against people or property? ____Yes ____No
Have you ever been expelled, dismissed, suspended or placed on disciplinary probation by any other
college, university or secondary school? ____Yes ____No
Currently, are there any criminal charges still pending against you? ____Yes ____No
Payment Options
All applications/license agreements must be sumitted with a $50 application fee and a
$200 security deposit. Please submit this $250 payment online at:
commerce.cashnet.com/1housing
A credit card or checking account information will be needed at the time of payment.
Payments made with a credit card are subect to a service fee. License agreements are
not considered to be submitted until the application fee has been paid.
Billing Option

If you are a registered student, you can choose to pay your rent monthly or by semester.
All charges will be posted to your student account and all payments must be made at the
Cashier's Office or through my pipeline account.

If you chose to pay your rent monthly you must pay your rent on the 1st day of each
month and you must pay for the first month's rent prior to move in.

If you chose to be billed by semester you are required to make full payment for each
semester prior to the first day of classes at the Wayne State Cashier's Office or through
my pipeline account.

If you have a roommate, rent will start for everyone on the first day the first person
moves into the apartment.

Rent is divided by the number or residents that live in the apartment.

If you are a Faculty, Staff or approved unregistered students you must be billed and pay
monthly to housing.

You must pay my rent online at
https://hmsweb.housing.wayne.edu/studentweb/Login.asp?TargetPage=Default.asp by
the 1st day of each month.

You must pay for the first month's rent prior to move in.

If you have a roommate, rent will start for everyone on the first day the first person
moves into the apartment.

Rent is divided by the number or residents that live in the apartment.
______Rent billed and paid by semester. Payment must be made through your
pipeline account or to the Cashiers Office.
______Rent bill and paid by month. Payment must be made through your pipeline
account or to the Cahiers Office.
Please specify your move in date. We will try our best to accommodate the exact date you
would like to move in. However, depending on availability the date you request to move in
might not be able to be granted. Also, if you are going to have roommates please discuss your
move in date with them. Everyone's rent will start from the first day the first person picks up
their key.
Please indicate move in date:_____________________________________________
UNFURNISHED APARTMENT LICENSE AGREEMENT
HOUSING DATES OF OCCUPANCY:
A. I understand that my Housing License Agreement provides occupancy for an assigned apartment
in campus housing starting on the date of my assignment letter and ending on April 30, 2015.
B. I understand that if I need to extend my dates of occupancy beyond April 30, 2015, it must be
for a reason listed below.
a. My programs academic calendar goes beyond April 30, 2015.
b. I have an academic commitment (i.e. graduation or orientation) that requires me to be
on campus.
c. I have an official athletic commitment as required and arranged by my coach.
d. I will be taking classes after April 30, 2015.
C. I understand that the full terms of this license agreement will be enforced should I move in prior
to the date of my assignment letter or remain in my space after April 30, 2015.
PAYMENTS AND DUE DATES:
A. I understand when submitting my license agreement I will pay a $50.00 non-refundable
application fee and a $200.00 security deposit.
B. I understand that I agree to pay the amount of rent set by the WSU Board of Governors for my
apartment at the start of my license agreement or until the end of my license agreement which
is April 30, 2015.
C. I understand that rent is divided by the number of persons that live in an apartment.
D. I understand that the rent for everyone moving into the apartment will start on the first day that
the first resident of the apartment moves in.
E. I understand that failure to utilize the assigned apartment does not cancel my financial
obligation.
F. I understand that if I am removed from housing or the University I am responsible for my
housing rent charges for the remainder of the academic year.
G. I understand that failure to pay my housing rent charges in full may result in removal from my
apartment and I will still be responsible for all of my housing rent charges for the remainder of
the academic year.
H. I understand that if I need to extend my date of occupancy beyond April 30, 2015, I will be
charged up to the day I properly check out of my apartment and return my key.
I. I understand that if I am a registered student, I can choose to pay my rent monthly or by
semester. All charges will be posted to my student account and all payments must be made at
the Cashier’s Office or through my pipeline account.
a. I understand if I chose to pay my rent monthly I must pay my rent on the 1st day of each
month and I must pay for the first month’s rent prior to move in.
b. I understand that if I chose to be billed by semester I am required to make full payment
for each semester prior to the first day of classes at the Wayne State Cashier’s Office or
through my pipeline account.
c. I understand that if I am billed by semester or monthly to my student account I will be
assessed late fees according to the University’s published late fee schedule for any late
payments.
J. I understand that if I am a Faculty, Staff or approved unregistered students I must be billed and
pay monthly to housing. I understand that I must pay my rent online at
https://hmsweb.housing.wayne.edu/studentweb/Login.asp?TargetPage=Default.asp by the 1st
day of each month.
a. I understand I must pay for the first month’s rent prior to move in.
b. I understand that a $50.00 late fee will be added to my account for any rent not paid by
the 5th of each month.
ROOM ASSIGNMENTS:
A. I understand that my apartment preferences will be considered, but may not be able to be
accommodated based on availability.
B. I understand that apartment changes may not be made without prior approval of my
Community Director.
C. I understand that apartment changes may not be made within the first three weeks of any
semester.
D. I understand that that an apartment change period will be offered each semester to help
accommodate me if I wish to move.
E. I understand that The Office of Housing and Residential Life may change my room assignment at
any time if the University deems it to be in the University's best interest or in the best interest of
the student.
F. I understand that if I am reassigned at the discretion of the University, I will be
charged/prorated for the apartment at the rate of the lower cost apartment.
G. I understand that the University reserves the right, with no liability, to store, for a limited period
of time, or discard any belongings remaining in a housing unit or facility if the housing
assignment has not been vacated by a prescribed time or has been reassigned to another
student.
H. I understand that only assigned persons are permitted to reside in campus housing.
I. I understand that if I need any special accommodations for a documented medical reason it is
my responsibility to inform the Office of Housing and Residential Life of my needs on the online
license agreement at the time that I sign my license agreement. I also understand that the Office
of Housing and Residential Life may consult with other University Offices to determine what
appropriate accommodations are needed.
J. I understand that Wayne State University does not have any reports or record pertaining to the
presence of lead-based paint except in Chatsworth Apartments. I acknowledge that I have
reviewed the pamphlet entitled "Protect Your Family from Lead in Your Home", online at
http://epa.gov/lead/pubs/leadpdfe.pdf.
CANCELLATIONS:
A. I understand that I do not have the right to cancel this license agreement unless I meet one of
the following reasons:
a. I can cancel for any reason up until June 30, 2014.
b. I can cancel for any reason within 14 calendar days from the day I signed my license
agreement. I understand that after I have checked in and picked up my key to my
apartment that the 14-day cancellation period no longer applies.
c. I can cancel if I graduate or I am no longer an enrolled student at the University. (Please
note that enrollment in online courses or satellite campus courses count as being an
enrolled student.)
d. I can cancel if I participate in a student teaching assignment that is further than 40 miles
from WSU’s Detroit campus.
e. I can cancel if I participate in an out-of-state or out-of-country internship, co-op, or
study abroad program.
f. I can cancel if my medical documentation proves I developed a medical condition after
signing my license agreement that campus housing cannot accommodate and prohibits
B.
C.
D.
E.
F.
G.
H.
living on campus. (Please note that the medical condition must be the student’s and not
a family member or a friend.)
I understand that, if I am permitted to cancel my Unfurnished Apartment License Agreement for
any reason, I will forfeit the entire $200.00 security deposit.
I understand that if I am approved for cancellation because I am no longer a registered student,
and I reenroll at the university within the same academic year, my license agreement will be
reinstated and I will be responsible for rent charges.
If approved for cancellation, I understand that I will be charged for rent until the date I complete
a proper checkout of my apartment.
If I am not approved for cancellation, I understand that I am liable for my apartment rent for the
spring/summer, fall and winter semesters as indicated on this agreement.
I understand that if I am academically dismissed or medically withdrawn from the University it is
my responsibility to request to cancel my license agreement by submitting a license agreement
cancellation to the Office of Housing & Residential Life.
I understand that in the event that I elect to move into off campus housing and/or turn in my
keys to the front desk during the term of this license agreement, I remain responsible for all
license agreement charges for rent for the 2014-2015 academic year.
I understand that all cancellation requests must be submitted to the Office of Housing and
Residential Life, Wayne State University, 5221 Gullen Mall, SCB 598, Detroit, Michigan 48202
using the License Agreement Cancellation Request Form.
ELIGIBILITY:
A. I understand that to be eligible to live in an unfurnished apartment I must be a junior, senior, a
student over 21 or a graduate/professional student.
B. I understand that to be eligible for University housing, I must be currently enrolled in a degreegranting program or a Wayne State University affiliated faculty/staff member, or a spouse, child
parent or other eligible person residing with an eligible student or faculty/staff member.
C. I understand that I must be enrolled two of the three semesters per year.
D. I understand that if I am not a registered full time student and I violate any housing policies, the
Office of Housing and Residential Life has the right to cancel my license agreement.
E. I understand that if I am not a registered full time student and my apartment is needed for a full
time student, the Office of Housing and Residential Life has the right to cancel my license
agreement.
F. I understand that if I am removed from the University for academic or disciplinary reasons, or a
verified withdrawal or leave of absence, I will be required to vacate my apartment within 48
hours.
COMPLIANCE WITH GUIDELINES AND REGULATIONS:
A. I understand that I am agreeing to abide by all rules and regulations established by the Office of
Housing and Residential Life, the Office of Dean of Students, and the individual living units. I
understand that copies of Wayne State University Student Code of Conduct and the Community
Living Guide are available to me through the WSU website and in hard copy, upon request. The
Community Living Guide is the Office of Housing and Residential Life’s official document that
outlines all of the rules and regulations of living in University housing.
B. I understand that the University reserves the right for authorized representatives of the
University to enter an accommodation at a reasonable time and upon reasonable notice to
perform cleaning, maintenance or inspection; or to enter whenever there is immediate or
serious threat to the safety, health or well-being of persons or property or reasonable cause to
believe there is a violation or suspected violation of University rules or regulations.
C. I understand that all public spaces in in DeRoy, Chatsworth and University Towers Apartments
are smoke- free environments.
D. I understand that all keys issued by the Office of Housing and Residential Life are the property of
the University. I also understand that I cannot exchange, or give my key to another person nor
duplicate my key.
E. I understand that I am responsible for keeping my apartment in the same condition it was in
when I moved in. I also understand if any damage occurs in my apartment I will be charged to
restore the damage.
F. I understand that University email is the official means of communication from the Office of
Housing and Residential Life and it is my responsibility to read, respond and follow all
communication sent to me via my Wayne State email.
G. I understand that if my apartment is destroyed or damaged in such way where it prevents the
use of the facility (i.e. strike, public emergency, natural disaster, riot or other unforeseen
circumstances) beyond the control of the University my license agreement may be terminated
at the discretion of the Chief Housing Officer and I will be responsible for the prorated charges
to the date of the termination.
H. I understand that the Office of Housing and Residential Life has the right to to use any
photographic image taken of me while in any public spaces, grounds, offices or University
sponsored events at the University. I also understand that the Office of Housing and Residential
Life has the authority to use my photographic image in all marketing materials (i.e. print
materials or online advertising). If I do not want to have my photographic image used by the
Office of Housing and Residential Life I must submit my request in writing to the Office of
Housing and Residential Life, Wayne State University, 5221 Gullen Mall, SCB 598, Detroit,
Michigan 48202 or via email at [email protected].
I. I understand that I am responsible and liable for any and all injury and damage to persons or
property caused, directly, or indirectly, by me or my guest’s intentional or negligent acts or
omissions (including injury or damage caused by student defective property). I also understand
that the University is not responsible.
J. I understand that I am responsible and liable for insuring my personal property, including losses
due to fire, smoke, water, theft, defective wiring or any other unforeseen occurrence beyond
the control of the University. I also understand the University is not responsible or liable for any
loss or damage to my personal property and does not provide any property or liability insurance
coverage for my benefit.
K. I understand that The Office of Housing and Residential Life has the right and may terminate this
license agreement if I violate the terms and conditions of this license agreement or any rules,
regulations and policies in the Community Living Guide, any municipal, state, or federal laws, or
the Student Code of Conduct or fails to pay any Agreement fees. I will be given written notice
of the termination and a specific date by which to vacate campus housing. If my license
agreement is terminated pursuant to this paragraph, I will not be entitled to a refund and I am
responsible for payment for the entire academic year. Charges for the remainder of the license
agreement will be applied to my student account at the time of termination.
Signature:_________________________________________________________________Date:_____________