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Student Application Form

* indicates required field, if it doesn't apply to you, fill in "N/A" or "none" etc.

Date:*

Date Premises Required :*

Personal Information

Applicant’s Full Name:*

Age:*

Applicant’s Present Address:*

Phone:*

Email:*

Current landlord:*

Current landlord's phone:*

If currently in residence, Don’s name:*

Don’s phone:*

Address of premises to be rented:*

Type of accommodation desired:*

shared

apartment

number of bedrooms in the apartment:

house

number of bedrooms in the house:

Other,

please specify:

Pets to occupy premises:*

Employment / Financial / Personal Information

Queen’s program of study:*

Expected graduation date:*

Previous employer (incl. summer):*

Previous Employer Phone Number:*

Credit Reference (list bank, credit union, charge accounts, or other credit references)

1. Financial Institution:*

1. Phone number:*

1. Account number:*

1. Contact name:*

2. Financial Institution:*

2. Phone number:*

2. Account number:*

2. Contact name:*

Personal Reference (list profs, employers, or other references)

1. Name (of person giving personal reference):*

1. Relation to applicant:*

1. Phone number (personal reference):*

2. Name (of person giving personal reference):*

2. Relation to applicant:*

2. Phone number (personal reference):*

Referred to landlord by:*

I hereby authorize the person or firm to whom this application is submitted to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirement.

Full Name:*

Date Signed:*

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427 Albert Street | Kingston, ON

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