Rental Application Form
Southwestern Medical Park Apartments
The undersigned is applying to occupy a unit in Southwestern Medical Park Apartments (the
“Apartments”) at The University of Texas Southwestern Medical Center at Dallas (the
“University”).
Name: ____________________________________________________
Spouse/Roommate: ______________________________________________________________
Address: ____________________________City: _______________State/Zip:_______________
Telephone: Home______________________ Work: _______________Fax: ________________
Move-In Date Requested: ______________________________________________________
Please Circle One of the Following:
Medical Student MSTP Student Graduate Student Allied Health Student
Post-Doctoral Research Post-Doctoral Clinical Resident
Other (list department)___________________ Junior Faculty
Floor Plan Preference - Please number 1-5 with 1 indicating your first choice!
(While we cannot guarantee you will get your desired floor plan or apartment location, we will
make every
attempt to accommodate your request.)
One Bedroom: Two Bedroom:
Floor Plan A1 (654 sq. ft.) _______ Floor Plan B1 (1015 sq. ft.) ________
Floor Plan A2 (656 sq. ft.) _______ Floor Plan B2 (1,042 sq. ft.) _______
Floor Plan A3 (597sq. ft.) _______
Lease Term: All leases expire May 31
st.
Floor Preference: 1
stFloor _____ 2nd Floor _____ 3rd Floor _____
Please Circle the Following:
Do you require a handicap accessible unit (limited availability)? Yes No
Are you interested in a roommate? Yes No
May we give your email address to anyone interested in a roommate? Yes No
Please provide us with a current email address
____________________________________________________
Do you have another permanent email address?
___________________________________________________
How did you hear about us? ______________________________________________(i.e.
website, dept, friend)
Office Use Only
Deposit
Received______________________By______________________________Date____________
______
Apartment Number ____________________Assigned
By______________________Date__________________
Rent Amount_________________________Lease Dates
_______________________To___________________