The 500 Club Online Application


Personal Information

First Name

MI

Last Name

Date Of Birth

Home Address

City
            
State                  Zip    

Country

Home Phone (xxx-xxx-xxxx)

Local Phone (xxx-xxx-xxxx)

E-Mail Address
Male       Female

Requested Apartment Information
Apt. Type:

Requested Start Date

Requested End Date

Requested Roommate

Rates
     Rates for Fall 2009 - Spring 2010
Single
10 Month - $6,300.00
12 Month - $6,600.00
Double
10 Month - $5,725.00
12 Month - $6,150.00
     Rates for Fall 2010 - Spring 2011
Single
10 Month - $6,700.00
12 Month - $7,100.00
Double
10 Month - $5,950.00
12 Month - $6,375.00
     * Please call for summer rates


Parent/Guardian      Use Applicant's Address

First Name

Last Name

Relationship

Street Address

City
            
State                  Zip    

Home Phone (xxx-xxx-xxxx)

Work Phone (xxx-xxx-xxxx)

Primary Guardian

Parent/Guardian      Use Applicant's Address

First Name

Last Name

Relationship

Street Address

City
            
State                  Zip    

Home Phone (xxx-xxx-xxxx)

Work Phone (xxx-xxx-xxxx)

Primary Guardian