CSU HOUSING APPLICATION
DEPARTMENT OF RESIDENCE LIFE
2450 Euclid Avenue | Cleveland, OH 44115 | 216.687.5196 | Fax 216.687.5156 | www.csuohio.edu/reslife
1. Please submit your application with a $50 non-refundable application fee in a check or money order made out to Cleveland State
University; $25 of this application fee will be applied to your security deposit. The application fee is waived for current residents.
2. Accommodations are limited and will be leased on a first-come, first-served basis. The acceptance of this application does not ensure
an accommodation. An accommodation is reserved only upon execution of the housing agreement by all parties. Prices subject to
change.
3. For information or assistance in completing this application, please call 216.687.5196.
APPLICANT DATA
Name: ___________________________________________________________________________________________
(FIRST)(MIDDLE)
(LAST)
Permanent Address: ________________________________________________________________________________
(STREET)
(CITY)
(STATE)(ZIP)
Country (if not United States): __________________________________________________________________________
Home Telephone: (_______) _____________________ Cell Telephone: (_______) __________________________________
CSU E-mail Address: _________________________________________________________________________________
Student ID Number: _________________________________________________________________________________
Applying for:
I am a(n):
Fall 20___
Incoming Freshman
Fall 20___ Academic Standing:
Spring 20___
Summer 20___
Transfer Student
Freshman
Current CSU Resident
Sophomore
Junior
Current CSU Commuter
Senior
Graduate
Law
High School Attended: _______________________________________________ Graduation Date: _____________________
Date of Birth: ________/ ________/ ________/ Male
(MO/YR)
Female
Please provide the information from one of the items below, and check the corresponding item:
Driver’s License
Passport
State ID
Will you be on an intercollegiate athletic scholarship?
Will you be on an Honors Program scholarship?
Are you a STEM Fellow?
Number:_______________________ State/Country:________________
Yes
Yes
Yes
No
No
No
COMMUNITY CONDUCT STANDARDS — An affirmative response must be accompanied by a written explanation of your specific situation.
Have you ever pled guilty or been convicted of a criminal offense or have charges pending against you at this time?
Yes
No
Have you ever been dismissed, suspended or placed on probation by any other college or university for a
NON-ACADEMIC reason?
Yes
No
Have you ever been evicted from any residence?
Yes
No
Have you ever filed bankruptcy?
Yes
No
CSU HOUSING APPLICATION
(CONTINUED)
DEPARTMENT OF RESIDENCE LIFE
2450 Euclid Avenue | Cleveland, OH 44115 | 216.687.5196 | Fax 216.687.5156 | www.csuohio.edu/reslife
COMMUNITY PREFERENCE
Requests are in no way guaranteed; if space is available, they will be filled on a first-come, first-served basis.
Numerically list choices in order of preference.
FENN TOWER
EUCLID COMMONS
1 bedroom, 1 bathroom
(double occupancy) Shared bedroom,
shared bathroom
1 bedroom, 1 bathroom, kitchenette
(double occupancy) Shared bedroom,
shared bathroom, living area and kitchenette
Shared Room
Shared bedroom and bathroom in 3-bedroom
unit, living room and kitchen
Private bedroom
Private bedroom, shared bathroom in 3- or
4-bedroom unit, living room and kitchen
2 bedrooms, 2 bathrooms, kitchenette
(quad occupancy) Shared bedroom, shared bathroom,
living area and kitchenette
LEASE TERMS REQUESTED
Academic Year
Academic Year lease term does not
include winter or spring break
Academic Year Plus Breaks
Academic Year Plus Breaks lease term includes
winter and spring break. Additional fees apply.
If you have already chosen your roommates, please indicate their name(s) below. All roommate requests must be mutual to be placed
together. Requests are in no way guaranteed:
1)_____________________________________________ 2)___________________________________________
3)_____________________________________________ 4)___________________________________________
If you fail to answer any question, or if you have given false information: (1) we are entitled to reject this application; (2) we will retain all
processing fees and deposits as liquidated damages for time spent and expenses; (3) we will terminate any right to lease the bedroom; and (4)
if you have signed a lease, it will be a violation of the lease.
By my signature I attest that the information contained herein is correct. The management is authorized to verify my credit history, and all
other submitted information for the purpose of evaluating this lease application.
I certify that the information provided on this application is accurate and complete. I understand that any misrepresentation or omission
may be cause for the University to revoke housing priveleges, deny or cancel admission and registration, revoke financial aid, refuse posting
of transfer credit and suspension from the University, if discovered subsequently.
Applicant Signature: ______________________________________ Date:________________________________________________
Cleveland State University is an Affirmative Action/Equal Opportunity Institution
160370 - REV. 5/12/16