General Application for University Housing The University of Texas at Tyler Dear Housing Applicant: We are pleased that you are interested in living in the dynamic on-campus communities here at The University of Texas at Tyler. Please complete the application below. Once we have received your application, we will process your information. You will not be assigned or reserved a room until you have paid housing deposit and submitted the on-campus housing contract. Information on both will be mailed/emailed to you in that order. Remember, a contract and/or lease cannot be issued until you have been formally admitted to the University. If you have any questions about this form or living on campus, please visit our website at www.go2uttyler.com/housing, or you can call us at (903) 566-7008. Thank you for your interest in UT Tyler! Sincerely, Director of Residence Life General Personal Information: Please Print or Type Name: Birth date: First Middle Last Cell phone: Home address: Number Street Apt. Home phone: E-mail: City State Zip Code Student ID number: (Please do not enter your Social Security number) Female Male Have you been convicted of a felony or misdemeanor? Yes No If yes, please explain on a different sheet of paper and enclose. Please indicate any special services you need. (e.g. disabilities, medical concerns, etc): Did your parents/guardians claim you as a dependent on their most recent income taxes? Under FERPA (Family Educational Rights and Privacy Act), the University may disclose to parents information from the educational record of a student who is dependent under federal tax laws without the student s consent. Name and ID number of preferred roommate(s): Please note that roommate requests must be mutual to be honored and will be honored as space permits, and that both roommates must submit an application and be accepted to the same community.
Select Contract Length (one only): Academic Year (August to May) Spring Only (January to May) Full Year (only available at University Pines. Summer extensions will be available to all other housing residents in February) Select your Community by ranking (1 st, 2 nd, and 3 rd ) your three most preferred room types. Patriot Village University Pines Eagle s Landing 4 bedroom/2 Bath Efficiency 1 Bedroom/1 Bath 2 Bedroom/1 Bath 1 Bedroom/1 Bath 2 Bedroom/2 Bath Ornelas Hall 2 Bedroom/1 Bath 3 Bedroom/3 Bath 3 Bedrooms/1 Bath 4 Bedroom/2 Bath 4 Bedroom/ 2 Bath Double Occupancy/1 Bath 4 Bedroom/4 Bath Thank you for applying with us! Once you send this application to the address below, you will be sent housing deposit information. A contract and/or lease cannot be issued until you have been admitted to The University of Texas at Tyler. The Office of Residence Life will send more information to you at that time. Remember, no room assignments will be given until housing deposit and the on-campus housing contract is received and processed. Send all correspondence and applications to: UT Tyler Residence Life 3900 University Blvd. Tyler, TX 75799 Phone: (903) 566-7008 Fax: (903) 565-5811 For community specific questions, please call: UT Tyler Apartments: (903) 566-7008 University Pines: (903) 566-3565 PRIVACY NOTICE: With a few exceptions, you are entitled to be informed about the information UT Tyler collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review this information. Under Section 559.004 of the Texas Government Code, you are entitled to have UT Tyler correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in the University of Texas System Business Procedures Memorandum 32. The information that UT Tyler collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time. I understand the information submitted in this application will be relied upon by officials of the UT Tyler Residence Life Office to determine my eligibility for residency. I authorize the UT Tyler Residence Life Office to verify the information I have provided and to gather relevant data, including a check of my credit history, for the purpose of evaluating this application. I certify the information in this application is complete and correct and understand the submission of false information is grounds for rejection of my application, the withdrawal of any offer of acceptance for residency, or eviction from the premises. Signature: Date:
THE UNIVERSITY OF TEXAS AT TYLER Department of Residence Life ON-CAMPUS HOUSING CONTRACT Please complete and sign: Return white copy to Residence Life, retain yellow copy for your files. Emergency Contact Name: Gender: Date of Birth: ID Number: Name: Phone Number: Relationship to Resident: This On-Campus Housing Contract (the Contract ) is a contract for 2014-2015 Academic year granting a license to use a room in a University housing facility on the terms and conditions stated herein. The Contract Period starts on August 21, 2014 and ends May 2, 2015. Eagle s Landing: Patriot Village: Ornelas Residence Hall: 1-bedroom $ 7020.00 2-bedroom $ 7904.00 Double Occupancy $ 5679.00 2-bedroom $ 5085.00 4-bedroom $ 6611.00 Triple Occupancy $ 6353.00 3-bedroom $ 4860.00 4-bedroom $ 4320.00 Townhome $ 4500.00 *Rates are calculated based on 9 months occupancy (August through May). The Contract Rate does not include a meal plan. For mandatory meal plans and costs visit this website: http://www.campusdish.com/en-us/cssw/univtexastyler/mealplans/ I/We the under signed Student and Guarantor, if applicable, certify that I/we have read in full the separate document entitled On- Campus Housing Contract Terms and Conditions and understand and agree that the terms of that document are incorporated into this contract and both documents constitute the Contract. I/We acknowledge that the Department of Residence Life will not grant the license described herein unless personal guarantee of payment of all charges or obligations under the Contract is made. I/We, jointly and severally, further agree to pay all charges arising under the Contract and any extension thereof when due and in accordance with the regulations of The University of Texas at Tyler, together with all fees and other reasonable costs for the collection of any amount not paid when due. A student under the age of eighteen (18) years is required to have this Contract signed by a parent, guardian or other person of legal responsibility as the Guarantor. The execution of this contract by Student and Guarantor, if applicable, constitutes acceptance of the Contract. Student s signature: Date Student s E-mail address: CONTRACT GUARANTOR: (required if student is under 18 year) Guarantor s Name(PRINT) Signature Home address: City State Zip Contact information: E-mail Address Home Phone
Renter s Insurance Notice The University of Texas at Tyler strongly advises that students living in housing purchase personal renter s insurance. UT Tyler is not responsible for loss or damages to personal property by theft, fire or other casualty, whether such losses occur in your room, public areas, or elsewhere. We recommend that you check your family s homeowners insurance policy, as college students may be covered under that policy. Please sign and return the bottom portion of this form to the Residence Life Office. Thank you! I have read and understand the Renter s Insurance Notice. Name (Sign): Date: Name (print): Date:
The University of Texas at Tyler Residence Life UC 3320 3900 University Blvd. Tyler, TX 75799 Acceptance/Rejection form as explained in attached letter: I understand that I have been automatically assigned to University Pines. I accept this assignment to University Pines, and my security deposit and non-refundable lease contract processing fee checks are enclosed. Please enclose a check for $125.00 made payable to University Pines Apartment and Chase Bank, Trustee for the security deposit and a check for $125.00 made payable to University Pines Apartment and Chase Bank, Trustee for the non-refundable lease contract processing fee. Send all payments to: 3333 Varsity Drive, Tyler, TX 75701. Once this form is received; your University Pines lease contract 2014-2015, will be mailed out. You will not be assigned a room until deposit and contract have been received. I reject the assignment and wish to be assigned to UT Tyler s Patriot Village, Eagle s Landing, or Ornelas Hall. My preference is indicated on my General Housing Application on file in Residence Life office. Please enclose a check for $250.00 made payable to UT Tyler. Deposit includes $200.00 security deposit (credited to your student account, less any damages, when you permanently checkout of on-campus housing) and a $50.00 non-refundable application fee. The security deposit, $200.00, is refundable as follows: If this is your first time to live on-campus and you cancel before June 1, 2014, you will receive a refund of your deposit minus the application fee. If this is not your first time to live on-campus and you cancel before May 1, 2014, you will forfeit your deposit. Please send form and deposit in the enclosed envelope. Note: If you have not received your student ID number yet, please include on your check; driver s license number and date of birth of the person signing the check. Your UT Tyler On-Campus Housing Contract 2014-2015 is enclosed. You will not be reserved a room until deposit and contract have been received in Residence Life Department. Room assignments and roommate contact information will be sent to your email in July. Student s Signature Date Please print name: Student s ID Number What is your major? You may fax this form to: 903-565-5811, please indicate how deposit will be paid.