Family Housing
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Date ___/___/____
APPLYING FOR SEMESTER: Spring 2010 Summer 2009 Fall 2009
MARITAL STATUS: Married Single Divorced
DATE MARRIED OR PLANNING MARRIAGE: ___/___/____
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Eastern Kentucky University Family Housing |
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BROCKTON APARTMENT APPLICATION Date ___/___/____ APPLYING FOR SEMESTER: Spring 2010 Summer 2009 Fall 2009 MARITAL STATUS: Married Single Divorced DATE MARRIED OR PLANNING MARRIAGE: ___/___/____
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(1)
Mr./Ms. ____________________________________ Birth Date ___/___/____
Last First Middle
I. D. # or SS #: _____________ Student Classification: Undergraduate Graduate
Major ____________________________ College ___________________________
How many hours will you be taking this semester? ___ Years attended college? ___ |
(2)
Spouse ____________________________________ Birth Date ___/___/____
Last First Middle
I. D. # or SS #: _____________ Student Classification: Undergraduate Graduate
Major _____________________________________ College ____________________________________
How many hours will you be taking this semester? _____ Years attended college? _____ |
(3) NAMES OF CHILDREN (2 children maximum, must be under age 18) 1. ______________________ Age _____ 2. ________________________ Age _____ |
(4)
Current mailing address: ___________________________________________________________
___________________________________________________________
Phone (daytime) _______________ (evenings) _______________
In case of emergency: Name ___________________________________________________________
Address ___________________________________________________________
Phone (daytime) _______________ (evenings) _______________
WE WILL NEED: • Marriage License or Certificate • Birth Certificates for all children • Proof of student status
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