Student Leasing Application

The following application is for students only.

If you are not a student, please print/fill out and mail/drop-off the Non-Student Rental Application.

Occupancy
Property of Interest (if known) 
Do you require any specialized accommodations made before occupying the property?  Yes  No 
If Yes (above), please describe: 
Personal Information
First Name
Last Name
Date of Birth
Gender
Male
Female
Email
Home Phone
Cell Phone
Are you a U.S. citizen?
Yes
No
Are you the Primary Spokesperson for your Rental Group?
Yes
No
What is the best way to contact you?
Cell Phone
Home Phone
Email
Other Occupants
For occupants to receive the same emails as you, check the box after their email address.
Name #1
Age
Phone
Email
Name #2
Age
Phone
Email
Name #3
Age
Phone
Email
Name #4
Age
Phone
Email
Name #5
Age
Phone
Email
Name #6
Age
Phone
Email
Name #7
Age
Phone
Email
Emergency Contact
Closest Relative or Other Contact
Name
Relationship
Street Address
City / State / Zip
   
Phone #
Email
Residence(s)
Current Address (Physical)
Street Address
City
State
ZIP
Landlord's Name
Landlord's Phone
Present Rent
How Long?
Previous Address (if less than one year at current address)
Street Address
City
State
ZIP
Landlord's Name
Landlord's Phone
Present Rent
How Long?
Mailing/Permanent/Security Deposit Address
If different from Emergency Contact address
Street Address
City
State
ZIP
Scholastic
What School/University will you be attending during lease term?
Upcoming Year (1st, 2nd, 3rd, 4th)
Full Time
Part Time
Graduate / Undergrad, Course of Study
Expected Year of Graduation
Extra Curricular Activities / Sports Involvement
Employment
Current Employer
Employer's Name
Phone #
Street Address
City / State / Zip
   
Position
Salary
How Long?
Past Employer (If less than 6 months at current employer)
Employer's Name
Phone #
Street Address
City / State / Zip
   
Position
Salary
How Long?
Criminal History
Have you ever been convicted of a felony? Yes   No

If so, state the nature of the offense, the county, state, and/or country which you were charged and/or tried, and the date of the trial and sentence given to you, if convicted:
How Did You Learn About Our Properties?
  University Offgrounds Housing Office

  Apartment Search Magazine

  Embarq Yellow Pages

  UVA Phone Directory

  Craigslist

  Twitter

  Facebook

  Google

  UniversityOffGrounds.com

  BRAC.com
  VelikyRentals.com
Please tell us how you found our site...
  UVA School/Department
Which school or department?
  Flyers/Brochures
Where did you get the flyer/brochure?
  Friend
If friend is a current/past resident, what is their name?
  Drive By / Curb Appeal
If so, what attracted you?
  Previously Rented
If so, what property address did you rent and when?
  Other
Please specify...
Disclosure
  1. Applicant hereby agrees/authorizes Veliky LC and its agents to verify: student or employment status, social security number, information regarding applicant's credit history, rental history, and criminal record which may include screening through a sex offender search and against the Office of Foreign Assets Control (OFAC) as a result of the USA Patriot Act.
  2. Applicant authorizes verification of all references given herein, and release of information to/from Landlord or any Credit Bureau or reporting agency. Applicant authorizes Veliky LC and its agents to disclose information to future Landlords or other 3rd parties if requested in the ordinary course of business for legitimate purposes as so determined by Veliky LC and its agents. This authorization shall continue throughout the application process, the rental term, and after any termination or default of the rental agreement.
  3. Applicant hereby declares that he/she is of legal age and that the statements above are true and understands that any rental agreement made on the basis of the information may be terminated at any time at the landlord's option if this information is found to be false.
  4. Deposits made are non-refundable and will be applied to security deposit only. If there is no lease, the deposit is forfeited.
  5. A Security deposit, equal to one month's rent, will be required at the signing of a lease. The first months rent to be paid before occupancy. Security deposit will not be applied for any rental payments.

Checking this box signifies that you agree to the terms and conditions contained in this application:

  I Agree