| Applicant Information |
| First Name: |
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| Last Name: |
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| Permanent Address: |
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| Suite/Apt: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Roommate Request/Suggest |
| Full Name: |
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| Full Name: |
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| Contact Information |
| Cell Phone: |
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| Parent Full Name: |
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| Parents Phone: |
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| Email: |
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| Room Information |
| Room Capacity: |
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| Gender: |
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| Other Information |
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I understand that my spot is not confirmed until my $200 deposit is received and I have signed the Housing Covenant and Lease Agreement.
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I understand that a roommate will be placed in my room if I do have a requested roommate or have not chosen a single occupancy room
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I authorize University of Minnesota | InterVarsity Christian Fellowship to verify my credit and employment history. I also authorize a personal background check for my safety and the safety of others in the house.
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