Brittany Apartments Application Form 2015-2016


243 E. 500 N. * Provo, UT 84606 * (801) 374-9788 *
______________________________________________________ _________________
Applicants First and Last Name
Today’s Date
Current Age
Please check all that apply:
I am applying for
[ ]
Spring/Summer 2015 Term (4/27/15 to 8/15/15)
[ ]
Spring 2014 Term (4/27/15 to 6/19/15)
[ ]
Summer 2012 Term (6/20/15 to 8/15/15)
[ ]
Fall/Winter 2015-2016 Term (8/17/15 to 4/23/16)
[ ]
Year Lease (4/27/15 to 4/23/16)
[ ]
Year Lease (8/17/15 to 8/13/16)
[ ]
Other (Please list Dates) _______________________________________
How did you find out about the Brittany? _______________________________________________
CERTIFICATION OF STUDENT STATUS: I hereby certify that I am a "student" and am eligible to rent and reside in BYU Contracted Off-Campus Housing, (“Contracted
Housing”), that is, I am a full or part-time student of BYU, enrolled in daytime or evening classes; or, I have applied to BYU or a qualifying institution and been
accepted for enrollment; or, I am enrolled in and will provide proof of attending at least 75% of classes at an LDS institute program for credit; or, I am a student of an
educational institution which provides jointly administered Title IX sex segregated housing through common off-campus landlords (Utah Valley University, Stevens
Henager College, Provo College, Paul Mitchell The School, Marinello Schools of Beauty, Acaydia School of Aesthetics, Aveda Institutes Provo, Nomen-Global
Language Centers, American Institute of Medical and Dental Technology, Renaissance Academe De Hair Design, Selnate International School), and I have elected to
live in such housing under the terms and conditions found herein and will provide proof of attending BYU or a qualifying institution upon request. I further certify that I
have never been evicted nor had my tenancy terminated from BYU Contracted Housing for violating the Residential Living Standards nor have I been dismissed,
suspended, nor have I withdrawn (in lieu of being suspended or dismissed) from BYU for non-academic reasons. I also understand if I am banned from BYU, I am not
eligible to live in BYU Contracted Housing. I agree to live in Contracted Housing under the principles of the Residential Living Standards, and the gender separation
policy and remain eligible as a student as defined in this paragraph. I recognize and understand that my Certification of Student Status is material to and relied upon by
the landlord in entering into this rental agreement and any misrepresentation found herein or change in student status is reason for immediate termination of tenancy and
such other legal and equitable remedies as the landlord may pursue. As a BYU student, I understand and agree that the landlord is required by BYU to verify each
semester/term through myBYU that I am a resident, with a current contract and will provide BYU my residential address. *(See paragraph #10)
Student Initials:
UNIVERSITY CONVICTED SEX OFFENDER POLICY: The university has determined that convicted sex offenders, whether required to register or not, pose a significant,
clear and present danger to residents living in Contracted Housing, and are not permitted to live in Contracted Housing. I hereby certify that I am NOT a convicted sex
offender and am eligible to rent and reside in Contracted Housing.
Student Initials:
PLACEMENT PREFERENCES: Landlord will try to accommodate placement preferences, however placement preferences are not guaranteed. Bedrooms are
not assigned, and are occupied on a first come, first serve basis. If tenant rents a shared room, tenant is required to move into a shared room (if one is available)
even if there are other unoccupied bedrooms within the unit. Bedrooms may not be identical in size, shape, or orientation. Landlord reserves the right to move or
place a student in any opening available. Landlord cannot guarantee a specific apartment or the “perfect” roommates, even if you are currently living at the
Student Initials:
Birth Date (MM/DD/YYYY) __________________ Drivers License #________________________ State issued ______________
Marital Status
Do You Smoke?
Soc. Sec #_______-______-_________ If you do not have a Soc. Sec. # please provide us with your Visa #_______________________
I certify that I am a student at
Other ______________________________________________________________
Year in School:
Senior (Date of Graduation) _______________________
I am not a student
Student ID # __________________________ Email Address _______________________________________________________________
Current Phone# _______________________ Your Cell# ______________________ Permanent Home Phone # _______________________
Who provides the money that you will be using to pay your rent? Self
Other (specify) _________________________________
In case of emergency, please notify: ________________________________________ Phone _______________________________________


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