A Room Rental Application

BUSWELL STREET RESIDENCE LLC 13 BUSWELL STREET BOSTON, MA 02215 www.buswellstreetresidence.info ROOM RENTAL APPLICATION/INFORMATION SHEET Applying For: Room # ______ Rent $_________ Date________

NAME: _________________________ BIRTH DATE:___________ SSN:________________________ CELL PHONE #:__________________

EMAIL ADDRESS: ____________________________________

CURRENT ADDRESS: ________________________________________________________________ HOW LONG HAVE YOU LIVED AT CURRENT ADDRESS: _______________________________________ LANDLORD’S NAME: ______________________________________ P HONE: ____________________ GRADUATION SCHOOL ATTENDING DURING RENTAL: ________________PROGRAM:_________________YEAR:______ PHONE NUMBER OF SCHOOL PROGRAM OFFICE:____________________________________________ PARENT’S NAME & ADDRESS: _________________________________________P H: ______________ LOCAL EMERGENCY CONTACT: ________________________________________P H: ______________ CURRENT EMPLOYER: ____________________________

P OSITION:__________________________

HOW LONG AT CURRENT POSITION:___________________ SALARY/INCOME:_____________________ WHO WILL BE RESPONSIBLE FOR YOUR RENT:_____________________________________________ RENTING FROM: ________________________T O: _________________________ I HAVE READ THE ABOVE AND CERTIFY THAT ALL THE INFORMATION PROVIDED BY ME IS TRUE AND COMPLETE. SIGNED:_________________________________________ D ATE:___________________________ PRINTED:________________________________________ DOCUMENTS NEEDED TO PROCESS APPLICATION: 1) COPY/VERIFICATION OF INCOME, CHECKING/SAVINGS, AND/OR FINANCIAL LAST YEAR’S TAX FILING DOCUMENTS, AND PAY STUBS FOR THE LAST THREE MONTHS & CURRENT EMPLOYMENT VERIFICATION;; A BANK STATEMENT THAT REFLECTS ABILITY TO PAY RENT FOR DURATION OF AGREEMENT (DO NOT REVEAL CONFIDENTIAL BANK ACCOUNT NUMBERS); FINANCIAL AID APPROVAL FOR SCHOOL YEAR. (THIS REQUIREMENT ALSO APPLIES TO CO-SIGNERS) 2) IF YOU ARE AN INTERNATIONAL STUDENT, PLEASE PROVIDE A COPY OF YOUR FORM I-20 WITH YOUR APPLICATION. 3) COPY OF GOVERNMENT-ISSUED ID (DRIVER’S LICENSE, PASSPORT)