The Elysian

Applicant Info

First Name*:



Last Name*:



Middle Initial*:



Apartment you are applying for*:

Date Of Birth*:



Gender*:

M F 

Social Security Number*:

Drivers License Number / State of Issue / Vehicle Tag Number*:

E-mail Address*:

Cell Phone*:

Telephone*:

Current Address:

Address*:





City*:



State*:



Zip*:

Permanent Home / Summer Address:

Address:





City:



State:



Zip:

School Information

HS Attended:

University Attending:

Major:


Student Classification: (as of the fall)

 FR SO JR SR Grad Other

Guarantor Intent (Pick One)

If you do not have a guarantor, you must fill out the employment section below
 I intend to have a guarantor co-sign for my apartment. I intend to qualify for my apartment on my own

Employment Info

(if no Guarantor)
Current Employer:

Address:



State:

Zip:

Position:

Date Hired:

Supervisor:

Telephone:

Gross Monthly Income:

Previous Employment Information (if current employment is less than 12 mo.)
Previous Employer:

Address:



State:

Zip:

Position:

Date Hired:

Supervisor:

Telephone:

Gross Monthly Income:

Additional Income

Source / Amount per (Month / Year)

 Month Year
Source / Amount per (Month / Year)

 Month Year

Emergency Contact Info

In the event that you are seriously ill, missing, incarcerated or deceased, according to an affidavit of the person listed below, you authorize this person to enter your dwelling and remove all contents, as well as your property in the mailbox, storerooms and common areas. In case you become seriously ill or injured, you authorize us to send for an ambulance at your expense, though we are not legally obligated to do so.

Name*:

Relationship*:

Address*:

City*:

State*:

Zip*:

Telephone Number*:

Alternate Telephone:

Applicants Digital Signature
(Type Your Name)*

Type the text in the image: