IT'S YOUR LIFE AT REINHARD VILLAGES

Application Date: June 18, 2013

Fields marked with an asterisk * are required.

PERSONAL INFORMATION

*Clarion ID Number

*Student Status Full-Time Part-Time

*Class Status as of 2012-2013

*First Name

Middle Initial

*Last Name

*Permanent Address

*City

*State

*Zip/Postal Code

*Local Address

*City

*State

*Zip / Postal Code

*Local Phone

*Cell Phone

*Email

*Gender Male Female

*Date of Birth (MM/DD/YY)

*Name of High School

UNIT INFORMATION

*Select Academic Term to begin Lease

*Please select a bedroom floor plan

*Are You a Current Resident of Reinhard Villages? Yes No

*How long have you lived at Reinhard Villages? 2012-2013 will by my ...

If you are an Incoming Freshman and are interested in a Living Learning Community, please select one of the following:

CRIMINAL HISTORY

*1) Have you ever been convicted of and/or pled "guilty" or "no contest" to any felony regardless of whether such action resulted in jail or prison time served and/or deferred adjunction?

Yes No

*2) Have you ever been convicted of and/or pled "guilty" or "no contest" to any misdemeanor involving theft, burglary, pornography, physical assault, indecent exposure, sexual molestation and/or any unlawful conduct involving a minor, regardless of whether such activity resulted in jail or prison time served and/or deferred adjunction?

Yes No

*3) Are you currently on probation, parole, or suspended sentence for any conviction?

Yes No

PARENT / GUARANTOR INFORMATION

*Parent/Guarantor Name

*Parent/Guarantor Home Address

*City

*State

*Zip / Postal Code

*Contact Phone

Contact Cell Phone

*Parent Email

PAYMENT INFORMATION

Application Fee: $ [please select an academic term]

Service Fee: $ [please select an academic term]

TOTAL DUE: $ [please select an academic term]

PAYMENT INSTRUCTIONS:

Click the "Pay Now" button. A new browser tab or window will open where you will be able to enter your payment instructions for our Credit Card handler — Pay Trace.
Enter the "Total Due" amount above into the field labeled "Payment Amount."
Enter "9999" into the field labeled "Apartment Number."
On the following screen you will see a Transaction ID and Date/Time for your payment.
Return to this form to copy-and-paste the Transaction ID and the Date/Time into the corresponding fields below.
Click the Submit button at the bottom of this form once the form is complete.

In order to fully complete your application, you must click the Submit Housing Application button at the bottom of this form once the form is complete.

*Transaction ID:
*Transaction Date/Time:

Human Validation

*Please enter the word pictured to the left as anti-spam protection.

DISCLAIMER INFORMATION

The undersigned hereby offers to rent premises on terms and conditions described herein and upon acceptance of this application agrees to sign a rental or lease agreement and pay to all sums due, including required fees. Application fees and other fees are non-refundable. If my application is accepted and I fail to execute the lease agreement or notify management of my intent to cancel in writing within 48 hours, I agree to forfeit the full amount of all fees. The undersigned warrants that the above stated information is true and correct and authorizes verification of such information including, but not limited to, verification of employment, rental history and student status.

Reinhard Villages is owned by Clarion University Foundation, Inc. and managed by EdR