TENANT INFORMATION
First Name MI Last
Name DOB
Driver’s license # SS# Phone number
E-mail address Student ID# (if
applicable)
Current address City State Zip
How long have you lived at
this address? ______ years _____ months
Name of current landlord Phone #
Previous address City State Zip
When did you live at this
address? _____________________________________
Name of previous landlord Phone #
Previous address City State Zip
When did you live at this
address? _____________________________________
REFERENCES
Please list two personal
references that live in Jackson County, IL.
First Name Last Name relationship phone #
First Name Last Name relationship phone #
Name of Employer Phone # City State
How long have you been
employed there? ______ years _____ months
Estimated monthly income
(from all sources): _______ *
* If you
are a student or work less than full time, we may ask your parents to co-sign
your lease
Have you ever been evicted?
If so, please explain: _____________________
STUDENTS
Are you a student? Y N (If no, please skip this section)
Student ID#
__________________ (Circle one) F. S. Jr. Sr.
Parent’s contact
information:
First Name Last Name phone
#
Address City State Zip Code
Will your parents be paying
any portion of our rent? Y N
What portion of your rent will your parents be paying? __________________
