Date* Name* First Last ID #*Current Campus Address* Street Address Address Line 2 City ZIP Code Married/Single?*MarriedSingleStudent/Alumni/Staff?*StudentAlumniStaffHome Phone*Work Phone*Desired date change?* Number of bedrooms requested?*Number of bathrooms requested?*Spouse NameNumber of children residing with you:TotalMaleFemale Reason for housing change:*What is the condition of your apartment?*PoorFairGoodIs there any furniture owned by the school that is in your apartment?*YesNoHave you ever failed a housing/maintenance inspection?*YesNoHow many times have you failed an inspection?Please agree to the following statement* I understand there is a $150.00 housing transfer fee required upon approval for family apartments or $75.00 for singles dorms.