Name
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First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Sex/Gender
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Male
Female
EmplID
Birth Date
*
MM
DD
YYYY
Term Housing Needed
*
Fall 2024
Summer 2024
Spring 2025
Which Location would you like to live in? (preference only)
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Eagle Valley Apartments
Midway Townhouses
No Preference
Would you like a SINGLE or DOUBLE occupancy room?
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Single
Double
ADA Accommodations
LIST ALL accommodations you may need per the ADA to assist in living in our apartments due to disabilities. If your application is approved for processing, you will need to supply supporting documentation.
Have you ever filed for bankruptcy?
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Yes
No
Have you ever been evicted from a tenancy or left owing money?
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Yes
No
Have you ever been convicted of a crime?
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Yes
No
Do you currently use illegal substances?
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Yes
No
Are you in the Great Expectations program?
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Yes
No
If you andwered "Yes" to any questions regarding bankruptcy, eviction, or criminal history please use this box to provide more information.
Vehicle Year, Make & Model
*
Vehicle Tag Number and State of Registration
Whose income will be used to qualify for housing?
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Guarantor
Applicant
Occupation 1
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Employer/Company
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Supervisor Name
First Name
Last Name
Supervisor Phone
(###)
###
####
Occupation 2/Other income (Explain)
Guarantor Name (If Applicable)
First Name
Last Name
Relationship to Applicant
Guarantor Phone
(###)
###
####
Guarantor Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Please include any other information you believe would help evaluate this application
I/we, the undersigned, authorize Southwest Virginia Community College Real Estate Foundation, LLC., Landlord, and their agents to obtain an investigative consumer credit report including but not limited to credit history, OFAC search, landlord/tenant court record search, criminal record search, and registered sex offender search. I authorize the release of information from previous or current landlords, employers, and bank representatives. This investigation is for resident screening purposes only, and is strictly confidential. This report contains information compiled from sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold Victor Scott, Landlord and his agents free and harmless of any liability for any damages arising out of any improper use of this information. Important information about your rights under the Fair Credit Reporting Act: • You have a right to request disclosure of the nature and scope of the investigation. • You must be told if information in your file has been used against you. • You have a right to know what is in your file, and this disclosure may be free. • You have the right to ask for a credit score (there may be a fee for this service). • You have the right to dispute incomplete or inaccurate information. Consumer reporting agencies must correct inaccurate, incomplete, or unverifiable information. These reports are being processed by Southwest Virginia Community College Educational Foundation Real Estate LLC. A summary of your rights under the Fair Credit Reporting Act is available by visiting http://www.consumerfinance.gov/learnmore or writing the Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
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Signed/Applicant
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Date
*
MM
DD
YYYY
Date
*
MM
DD
YYYY