Fillable Single Occupancy Request Form printable pdf download

Single Occupancy Request Form

Download a blank fillable Single Occupancy Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Single Occupancy Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Print Form

California State University, Los Angeles

Housing Services

SINGLE OCCUPANCY REQUEST FORM

5300 Paseo Rancho Castilla

Los Angeles, CA 90032

(323)343-4800 Fax: (323)343-6465

Rev. 10/10/12

The highest priority for single occupancy will be given to disabled students who have provided the appropriate

documentation from the Office for Students with Disabilities (OSD). After that, priority for single occupancy will be

determined by academic classification. Graduate students will be given the first priority, followed by seniors, then

juniors, then sophomores, and finally freshmen. Payment history will also be considered for all single requests forms

submitted by continuing students. Please complete the following for full consideration of your single occupancy request:

Name:____________________________________________________

CIN#:_______________________________

Last,

First

Street Address:_____________________________________________

Apt.# :_________

Box#:__________

City:______________________________________________________

State:__________

Zip:____________

Phone:____________________________________

Housing Status:

Single Request Submitted for which quarter:

___ New Student (1

time living in CSLA housing)

___ Fall

___ Winter

___ Continuing Student (currently live in CSLA housing)

___ Spring

___ Summer

Academic Classification:

Gender:

Do you receive financial aid?

___ Freshman

___ Sophomore

___ Junior

___ Male

___ Yes

___ Senior

___ Graduate

___ Female

___ No

# of units registered for this quarter? ____

Are you requesting a single based on a disability?

___ Yes (If “yes” then please attach a copy of the letter from the OSD in which they recommend single occupancy

to accommodate your disability

___ No

Notes:

•

Single requests are considered on a first come, first serve basis and are prioritized by date received in the Housing

Services office. Request forms will remain on file for one quarter and will need to be resubmitted if interested in

single occupancy for the following quarter(s).

•

If approved, a resident will be required to move to a new location. Furthermore, the resident must comply with

the applicable payment schedule as outlined by Housing Services.

•

Single occupancy may be revoked in the event that the resident becomes delinquent in their rental

payments/obligations. If single occupancy is revoked then the resident will be required to move to a double

occupancy space.

•

If you require special accommodations please register with the Office for Students with Disabilities (OSD). You

can call them at (323)343-3140 or access their website at

For Office Use Only:

___ Approved

New Room Assignment: __________

___ Denied

___ Waiting List

Resource Coordinator Initials: _________

Single Occupancy Request Form

Related Articles

Related forms

Related Categories