advantage of an on-site Resource Center. The Resource ... Please submit all parts of the application together to avoid p
Student Housing Application 2012 - 2013
What is La Casa? La Casa is an innovative model in student housing that surrounds students with all the benefits and resources of on-campus living—plus the added advantage of an on-site Resource Center. The Resource Center provides a wide range of student support services that help in navigating the complexities of college life and developing leadership skills. It is a community of students from different universities who live and learn together in order to increase their chance of college success. La Casa is a place where you can live, learn, and thrive!
Who is eligible to live at La Casa? Only students who pre-qualify should complete a La Casa Application, supply required documentation, and pay a $50 application fee. To find out if you pre-qualify, be truthful in answering the following questions:
Are you a recent high school graduate or undergraduate-level college student?
Yes
No
Are you in pursuit of your first bachelor’s degree?
Yes
No
Are you willing to live with a roommate?
Yes
No
Will you maintain a full-time college enrollment status during your residence at La Casa?
Yes
No
Are you interested in mentorship and internship opportunities?
Yes
No
Note: If you answer yes to all of the questions, you pre-qualify to complete a La Casa Application. Space is limited. housing are not available.
Co-ed rooms and family
Important Dates The Academic Year leasing period begins mid-August 2012 and runs through mid-May 2013 (9 months). Our Academic Year is adjusted to match your university’s term. La Casa Application
Housing applications continue to be accepted until all available rooms have been assigned
La Casa Housing Contract (Lease)
Complete between May 15 – August 25, 2012
Room Assignment
Sent on or before July 6, 2012
Applications are reviewed in date order based on the date the file is complete. Please submit all parts of the application together to avoid processing delays.
Decision & Review Process La Casa Application is considered complete when the Director of La Casa at The Resurrection Project has received all required application materials. Invitations to live at La Casa and to sign a La Casa Housing Contract (Lease) will be extended to qualified applicants as space permits in ratios that provide equal representation of undergraduate college students by gender and grade level. Gender
To ensure an equal representation of males and females living at La Casa, 50% (5 suites) of our available 10-person suites are available for males and 50% (5 suites) are available for females. If La Casa does not receive enough applicants from a particular gender to fill their respective 50% requirement, then applicants of the opposite gender will be accepted in multiples of 10 to fill one of the suites belonging to the other gender.
Under Age 18
Students who are under the age of 18 at the time of application are required to have a parent, legal guardian, or guarantor read, sign and date La Casa Application and La Casa Housing Contract (Lease). Additionally, by signing a La Casa Housing Contract (Lease), a student, parent, or guarantor guarantees payment and understands and is obligated to abide by the terms that are outlined. It is a binding contract for the full academic year (fall and spring semesters or equivalent fall, winter, and spring quarters) or that portion which remains when a student with parent, legal guardian, or guarantor contracts to enter La Casa after the fall opening date.
Applications are reviewed in date order based on the date the file is complete. Please submit all parts of the application together to avoid processing delays.
Instructions 1)
La Casa Application is considered complete when all required signatures, application fee, and supporting documents are received. Applications are considered incomplete and will not be processed if any of the following parts are missing: PART I. STUDENT HOUSING APPLICATION
Application Form - La Casa Application serves as a written request to live and learn at La Casa, including access to Student Housing and the Resource Center. A $50 non-refundable application fee is required at the time of submitting the La Casa application. Any application received without the application fee will not be processed. Do not send cash. Please make checks payable to The Resurrection Project.
PART II. FINANCIAL INFORMATION
Authorization of Release of Information – To determine eligibility for anyone who is seeking housing at La Casa, a credit report will be ordered and a criminal background check will be obtained. In the case of students who are under the age of 18 or who are otherwise applying as dependent students, a credit check will also be ordered for the parent, legal guardian or guarantor. In the case of students over the age of 18 who have no income or credit, a credit check will be ordered for the co-signer. La Casa Staff will not neglect or retain any student resident who subsequently engages in violence or some other act that results in harm to a person or property.
Financial Information Form– The Financial Information Form helps The Resurrection Project measure ability to pay and to assess income levels required of prospective students who want to live and learn at La Casa.
Copy of Financial Aid Award Letter – Submit a copy of the financial aid award letter supplied by the college that you plan to attend while living at La Casa Student Housing. This letter spells out the details of the financial aid offer made by the college.
PART III. LIVING-LEARNING COMMITMENT
La Casa Living-Learning Agreement Form – La Casa is more than a place to live. As a Live and Learn environment, we consider our academic support, internship, mentorship and service-learning programs to be essential means towards the realization of academic achievement, personal growth and future success. With that in mind, we require that all student residents of La Casa take part in at least one of our many program offerings and to attend at least four Resource Center events each semester in addition to their regular studies. It must be understood that student housing is only one component of the La Casa experience, an amenity if you will, and that to truly get the most out of your experience here, a certain level of commitment towards the academic and community-based goals of the program must also be achieved. Likewise, our programs will help give you valuable learning experience outside of the classroom and better prepare you for life after college and La Casa.
Proof of College Enrollment – La Casa residents are required ongoing full-time enrollment at an accredited, degree-granting college or university. Enrollment verification is required each school term to prove your student standing, that is, whether you are currently enrolled full-time or not. It must include student's name, class and college, major, dates of current term, and enrollment status. Any Enrollment Verification Form printed more than one month prior to submission of this application is not valid.
PART IV. YOUR ROOM PREFERENCES
Personal Preferences and Roommate Match Survey Form – Fill out this form accurately and honestly even if you list preferred roommates. La Casa Staff will use this information to assign a roommate in the event that you have no preferred roommate or if your room drops below occupancy.
Special Accommodations Request – La Casa provides accommodations to qualified students as required by state and federal law. You must request and submit the Request for Reasonable Accommodations form, verifying that the request is related to your disability and is necessary to access, maintain, or have full use and enjoyment of housing, with your housing application. Please note that if you fail to provide the Request for Reasonable Accommodation form or apply after May 1, your request may not be processed or provided in a timely manner. Special accommodation requests are not guaranteed and can be denied.
2)
All documents submitted become the property of La Casa and will not be released to the student or outside party for any reason.
3)
This application is valid only for the leasing period for which you are applying. If you do not move-in on the date or term for which you applied, you will have to apply again for a future date or term. If you would like to change your application to the next available date or term, you may request a changeover one time, in writing. The request must be received and approved by the Director of La Casa or her/his designee.
Send a complete application, fee, and supporting documents to: La Casa Student Housing The Resurrection Project Attn: Director of La Casa 1818 S. Paulina Street Chicago, Illinois 60608
Student Housing Application, 2012-2013 (PLEASE PRINT)
Student Data Name: First
Middle Initial
Last
Address: Street
Floor
City
Home Phone: (
State
Zip Code
)
Cellular Phone: (
)
E-mail: Date of Birth:
Gender:
Male
Female
Month / Day / Year
Social Security Number (SSN) or Individual Tax Identification Number (ITIN): Are you interested in mentorship and internship opportunities? How did you hear about La Casa?
Friend / Family Event Internet Search
Have you ever been convicted of a felony?
No
No
-
Yes
HS Teacher / Counselor Commuter Center On-Campus Advertising
College Staff I live in the community Other:
Yes
Please explain.
Housing Needs Are you willing to live with a roommate?
No
Yes
When do you plan to live at La Casa? (Select all that apply)
Fall 2012 Summer 2013
Winter 2013 Other:
Are you planning to study abroad this academic year?
No
Yes
If yes, when do you plan to study abroad? La Casa will not hold a space for you while you are away.
Fall 2012 Summer 2013
Winter 2013 Other:
Do you require any special accommodations?* If yes, briefly explain.
No
Yes
Spring 2013
Spring 2013
* SPECIAL ACCOMMODATIONS POLICY: La Casa provides accommodations to qualified students as required by state and federal law. You must request and submit the Request for Reasonable Accommodations form, verifying that the request is related to your disability and is necessary to access, maintain, or have full use and enjoyment of housing, with your housing application. Please note that if you fail to provide the Request for Reasonable Accommodation form or apply after May 1, your request may not be processed or provided in a timely manner. Special accommodation requests are not guaranteed and can be denied.
Int_Website
Educational Information High School:
Name of High School
City / State
From:
To:
Month / Year
Month / Year
From:
To:
Month / Year
Month / Year
From:
To:
Month / Year
Month / Year
From:
To:
Month / Year
Month / Year
Graduation Year
College / University:
Name of College
City / State
Name of College
City / State
Name of College
City / State
Graduation Year
Graduation Year
Graduation Year
What is your program of study? If you have not chosen a major or minor, simply designate “undecided.” Major(s): Minor(s):
Which of these statement best describes you? (Choose one)
I am enrolled at a four-year college or university; pursuing my first bachelor’s degree.
I am enrolled at a two-year college; I plan to transfer to a four-year college or university to complete my first bachelor’s degree.
I am enrolled at a two-year college or technical school; I will not transfer to a four-year college or university.
When you begin the 2012-2013 academic year, what will be your grade level? (Choose one)
Never attended college and 1st year undergraduate
Attended college before and 1st year undergraduate
2nd year undergraduate / sophomore
3rd year undergraduate / junior
4th year undergraduate / senior
5th year / other undergraduate
Other:
Residence at La Casa requires ongoing full-time enrollment status at an accredited, degree granting college or university. When will you be enrolled full-time? (Check all that apply) Fall 2012
Winter 2013
Spring 2013
Summer 2013
Other
I, the undersigned, am aware that my tenancy at La Casa is subject to confirmation. I understand that all of the information that I have provided on this housing application is true to the best of my knowledge. Any falsification may result in my removal from housing. I have thoroughly read this housing application and understand the information, policies, and procedures contained in it. I understand that omitting or falsifying information is grounds for denied housing and if misrepresentations are found after the housing agreement is signed, the rental agreement may be terminated.
Student Print Applicant’s Name | Imprima el Nombre del Solicitante
Print Guarantor’s Name | Imprima Nombre del Garante Print Co-signer’s Name | Imprima Nombre del Consignatario
X
X
Applicant’s Signature | Firma del Solicitante
Date | Fecha
Guarantor’s Signature | Firma del Garante Co-signer’s Signature | Firma del Consignatario
Relationship to Applicant | Relación
Date | Fecha
Authorization of Release of Information Applicant (Student) | Solicitante
Guarantor | Garante Co-signer | Consignatario
Name | Nombre:
Name | Nombre:
First / Primer Nombre
Middle / 2do Nombre
Last / Apellido
First / Primer Nombre
Address | Dirección: Street / Calle
City / Ciudad
State / Estado
Floor / Piso
Street / Calle
Zip Code / Código Postal
City / Ciudad
Social Security Number | Número de Seguro Social | ITIN:
-
Day / Día
Last / Apellido
Floor / Piso
State / Estado
Zip Code / Código Postal
Social Security Number | Número de Seguro Social | ITIN:
-
-
Date of Birth | Fecha de Nacimiento:
Month / Mes
Middle / 2do Nombre
Address | Dirección:
-
Date of Birth | Fecha de Nacimiento:
Year / Año
Month / Mes
Day / Día
Year / Año
Authorization | English I authorize and direct any federal, state, or local agency, organization, business, or individual release to 18th Street & Paulina Dorm, LLC and to The Resurrection Project any information or materials needed to complete and verify my student housing application at La Casa. I understand that, depending on program policies and requirements, previous or current information regarding my household will be needed. Verifications and inquiries that may be requested, include but are not limited to: Identity and Marital Status; Employment, Income and Assets; Past Residence and Rental Activity; Medical or Child Allowances; Credit and Criminal Activity; and Social Security Numbers. I understand that this authorization cannot be used to obtain any information about me that is not pertinent to my eligibility for and continued participation as a tenant. I agree that a photocopy of this authorization may be used for the purposes stated above. The original of this authorization is on file with the management office and will stay in effect for a year from the date signed or as long as I am a tenant of 18th Street & Paulina Dorm, LLC and The Resurrection Project. I understand I have the right to review my file and correct any information that I can prove is correct.
Autorización | Español Autorizo y dirijo a cualquier agencia, organización, negocio o persona federal, estatal, o local a que comparta con 18th Street & Paulina Dorm, LLC y con The Resurrection Project cualquier información o materiales que sean necesarios para completar y para verificar mi solicitud de uso de vivienda estudiantil en La Casa. Entiendo que dependiendo de políticas del programa y de requisitos, la información anterior o actual con respecto a mi cargo familiar y de hogar será necesaria. Las verificaciones e investigaciones que pueden ser solicitadas, incluyen pero no se limitan a: identidad y estado civil; empleo, renta y activos; historial de residencia y alquiler; subsidios familiares o médicos; crédito y actividad criminal; y número de Seguro Social. Entiendo que esta autorización no se puede utilizar para obtener ninguna información sobre mí para propósitos que no son pertinentes a mi elegibilidad y participación continua como arrendatario. Convengo que una fotocopia de esta autorización puede ser utilizada para los propósitos indicados arriba. La original de esta autorización está en archivo con la oficina de la gerencia y permanecerá en efecto por un año a partir de la fecha de firma o mientras sea un arrendatario de 18th Street & Paulina Dorm, LLC y The Resurrection Project. Entiendo que tengo el derecho de repasar mi archivo y corregir cualquier información que pueda probar está correcto.
Student Print Applicant’s Name | Imprima el Nombre del Solicitante
Print Guarantor’s Name | Imprima Nombre del Garante Print Co-signer’s Name | Imprima Nombre del Consignatario
X
X
Applicant’s Signature | Firma del Solicitante
Date | Fecha
Guarantor’s Signature | Firma del Garante Co-signer’s Signature | Firma del Consignatario
Relationship to Applicant | Relación
Date | Fecha
INT_Website
Financial Information Form The purpose of the Financial Information Form is to help The Resurrection Project obtain complete and accurate information about the funds available to prospective student residents who want to live and learn at La Casa. Membership at La Casa is restricted to applicants from household(s) who earn less than 80 percent of the area mean income. If an applicant’s household is above the maximum, the applicant is not eligible to live at La Casa. The verified annual gross household income must be less than the income limit. Student applicants who receive income, must attach copies of proof of income for the most recent 3 months. In the case of students who are under the age of 18 or are dependents, attach tax proof of income for parent(s), legal guardian(s), or guarantor(s). Income can include any of the following sources, plus others:
Employment Alimony Workers Compensation Other:
List all members in your household
Child Care Child Support Money from Family or Others
Age
Public Assistance SSI / SSDI Section 8 / Subsidy
Type of income received
Veteran Benefits Military Pay
Relationship to student
Full-time Student
Student
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
Student’s Employer Information List your employment history starting with the most recent. Employer 1: Name of Company
Position
Address (Street / City / State)
From:
To:
Month / Year
Month / Year
Name of Supervisor / Title
Phone
E-mail
Employer 2: Name of Company
Position
Address (Street / City / State)
From:
To:
Month / Year
Month / Year
Name of Supervisor / Title
Phone
E-mail
Co-Signer’s or Guarantor’s Employer Information If you are under the age of 18, list your guarantor’s employment history starting with the most recent. Do the same for your co-signer if you are a student over 18 who has no income or credit. Employer 1: Name of Company
Position
Address (Street / City / State)
From:
To:
Month / Year
Month / Year
Name of Supervisor / Title
Phone
E-mail
Employer 2: Name of Company
Position
Address (Street / City / State)
From:
To:
Month / Year
Month / Year
Name of Supervisor / Title
Phone
E-mail
I understand that all of the information that I have provided on this housing application is true to the best of my knowledge. Omitting or falsifying information is grounds for denial of student housing.
X Applicant’s Signature | Firma del Solicitante
X Date | Fecha
Guarantor’s Signature | Firma del Garante Co-signer’s Signature | Firma del Consignatario
Date | Fecha
INT_Website
Choose either Dependent or Independent student status Independent Student
Dependent Student Most students entering college directly after high school are Dependent Students— living and supported in a parent or guardian household. Gross Annual Income in 2011
An Independent Student is not listed as a dependent on a parent or guardian’s income tax form. Gross Annual Income in 2011
Parent(s) (enter ONLY if you are a dependent) Yourself
$____ ____ ____, ____ ____ ____
Yourself
$____ ____ ____, ____ ____ ____
$____ ____ ____, ____ ____ ____
Family Size in 2012
Family Size in 2012
Dependent Students ONLY (include yourself, your parent and any other dependents)
Independent Students ONLY (include yourself, your spouse and any other dependents)
___ ___
Number in College in 2012
Number in College in 2012
Dependent Students ONLY (include yourself and other dependents in college, but exclude your parent[s])
Independent Students ONLY (include yourself, your spouse and any other dependents in college)
___ ___
___ ___
___ ___
Anticipated Financial Support How do you plan to pay for student housing? Enter the expected amount of annual support from the sources listed below. Use an additional sheet of paper for explanations, if necessary. If you plan to make use of student financial aid program(s), submit a copy of your financial aid award letter. Assured Support (2012-2013)
Personal or Family Savings
Assured Support (2012-2013)
Personal Savings
Savings
$____ ____ ____, ____ ____ ____
Savings
$____ ____ ____, ____ ____ ____
Checking
$____ ____ ____, ____ ____ ____
Checking
$____ ____ ____, ____ ____ ____
Other
$____ ____ ____, ____ ____ ____
Other
$____ ____ ____, ____ ____ ____
_______________________________________ Spouse’s Name
$____ ____ ____, ____ ____ ____
Parents
Spouse
Money from sources other than savings.
Money from sources other than savings.
_________________________________________ Father’s Name
$____ ____ ____, ____ ____ ____
_________________________________________ Mother’s Name
$____ ____ ____, ____ ____ ____
Sponsor
Sponsor
Money from person(s) other than parents.
Money from person(s) other than spouse.
_________________________________________ Sponsor’s Name
$____ ____ ____, ____ ____ ____
_______________________________________ Sponsor’s Name
$____ ____ ____, ____ ____ ____
Financial Aid Programs
Financial Aid Programs
Only list amounts and types of aid which you are designating for cost of living, not other college related costs. Enclose a signed copy of your financial aid award letter.
Only list amounts and types of aid which you are designating for cost of living, not other college related costs. Enclose a signed copy of your financial aid award letter.
______________________________________________ Name of College or Funding Source Scholarships
$____ ____ ____, ____ ____ ____
_______________________________________ Name of College or Funding Source Scholarships
$____ ____ ____, ____ ____ ____
Grants
$____ ____ ____, ____ ____ ____
Grants
$____ ____ ____, ____ ____ ____
Work-Study
$____ ____ ____, ____ ____ ____
Work-Study
$____ ____ ____, ____ ____ ____
Loans
$____ ____ ____, ____ ____ ____
Loans
$____ ____ ____, ____ ____ ____
Other
$____ ____ ____, ____ ____ ____
Other
$____ ____ ____, ____ ____ ____
Work Income
Work Income
Include anticipated income earned from work (not work-study).
Include anticipated income earned from work (not work-study).
_________________________________________ Student’s Employer Name
Total Assured Support for 2012-2013
$____ ____ ____, ____ ____ ____
$___ ___ ___, ___ ___ ___
_______________________________________ Student’s Employer Name
Total Assured Support for 2012-2013
$____ ____ ____, ____ ____ ____
$___ ___ ___, ___ ___ ___
Living-Learning Agreement The mission of La Casa is to provide both a setting and an assortment of program initiatives aimed at assisting the next generation of community leaders to achieve their fullest potential. As a Live and Learn environment, we consider our academic support, internship, mentorship and service-learning programs to be essential means towards achieving that goal. With that in mind, we require that all student residents of La Casa take part in at least one of our many program offerings and are willing to attend at least four Resource Center events each semester in addition to their regular studies. It must be understood that student housing is only one component of the La Casa experience, an amenity if you will, and that to truly get the most out of your experience here, a certain level of commitment towards the academic and community-based goals of the program must also be achieved. Likewise, our programs will help give you valuable learning experience outside of the classroom and better prepare you for life after college and La Casa.
About You Why do you want to live at La Casa? Please explain.
Do you have any suggestions for events/programs? (i.e. workshops, social events, outings)
Your Agreement I understand that La Casa is more than a place to live. It is designed to function as an academic living environment. Therefore, by enrolling in this living-learning environment, I agree: What do you want to get out of your membership at La Casa? Select as many as apply.
(Please initial each statement to indicate you have read and understand the agreement.)
Academic Advice
Academic Assistance
Career exploration assistance
Connect with people from other backgrounds
Job / Internship search advice
Graduate school advice
_______ _______ _______
Expand personal network
_______
General supportive advice
Other: ______________________________________
_______ _______
Discuss your short and long term goals. Which are priorities?
_______
I will maintain full-time college enrollment status during my residence at La Casa. I am a degree-seeking, undergraduate level college student who will start or continue to work towards attainment of a bachelor’s degree. I will live with a roommate. I will ask for guidance from La Casa Staff, as needed. I will participate in a Mentorship Program and/or Internship Opportunities, as made available. I will actively participate in a minimum of four (4) Resource Center events each semester. The programs and services of La Casa include but are not limited to: A. Campus Connection B. Social Programs C. Student Supports D. Workshop Series E. Service Opportunities I will attend required meetings with La Casa Staff, including but not limited to: A. La Casa orientation meeting B. Check-out meeting, each end of term C. Monthly floor meetings with Resident Assistant
I have read and understand by my signature, each point indicated above. I am agreeing to actively participate in the programs and services of La Casa Student Housing and Resource Center.
X Print Applicant’s Name
Applicant’s Signature
Date
INT_Website
Personal Preferences & Roommate Match Lifestyle La Casa Staff makes an effort to place you with a roommate with whom you will be most compatible. Answer questions accurately and honestly. Please note that these are PREFERENCES, and your answers may not necessarily guarantee placement with someone whom you feel is a “perfect” roommate. Even if you have a preferred roommate(s) identified, answer the following questions regarding your roommate preferences. My average day begins…
Before 8 a.m.
8 – 10 a.m.
After 10 a.m.
My average day ends…
Before 8 p.m.
Before 11 p.m.
After 1 a.m.
I will primarily use my room to…
Study
Socialize
Some study, some socialize
I prefer to keep my room…
A complete disaster area… enter at your own risk
Somewhere in between
I have shared a bedroom at home…
Neat and orderly… everything has its place Always
Sometimes
Never
I am the type of student who…
Doesn’t mind sharing belongings
Will share belongings with prior permission
Choose neither to share nor borrow belongings
I can fall asleep with the light or TV…
On… Nothing bothers me when I sleep
Off… I need complete darkness and silence
The atmosphere I prefer when I am studying is…
Complete silence
Background noise is okay
Reading Computers Anime
Community Service Theater Dance
Sports; specify: ___________________ Music Other:__________________________
Things I like to do for fun…
Outdoor Activities Road Trips Exercise Watch movies/TV
Hang out with friends Play video games Sleep Go to parties
Read Listen to music Other: __________________________
The music I enjoy listening to is…
Alternative Heavy Metal Broadway Hip Hop Classical Opera Gospel Reggae
Country Heavy Metal Punk Dance New Age R&B Oldies Jazz Folk Christian Rap Popular Latin Other: _______________________________________________________
(Choose one)
(Choose one)
(Choose one)
(Choose one)
(Choose one)
(Choose one)
(Choose one)
(Choose one)
I have interests in… (Check all that apply)
(Check all that apply)
(Check your top 3 preferences)
On a scale of 1 to 3 (1 being a priority), select the top three (3) living conditions according to what is most important to you:
Sleeping Habits Use of Belongings
Room Use Habits Neatness Habits
Noise Level Interests and Hobbies
Roommate Draw-In All roommate preferences must be listed on each others’ applications and applications must be submitted together to ensure placement together. Please consult with the person(s) you list before submitting this application. All applications must have all names listed. If you do not list a preferred roommate, you will be assigned to a room with a roommate by La Casa Staff. Roommate Name
College Attended
Phone Number
E-mail Address
Relationship
If you have other friends that you would like to live near (same floor or hall), please list their names below (this is a PREFERENCE, not a guarantee):
Roommate Name
College Attended
Phone Number
E-mail Address
Relationship
Roommate Name
College Attended
Phone Number
E-mail Address
Relationship
I, the undersigned, am aware that my tenancy at La Casa is subject to confirmation. While La Casa Staff will make an effort to honor my lifestyle and roommate preferences, I am not guaranteed a perfect roommate or living arrangement.
X Print Applicant’s Name
INT_Website
Applicant’s Signature
Date
1818 S. Paulina Street | Chicago, Illinois 60608 | (312) 666-1323 ext. 2400
[email protected] | www.lacasastudenthousing.org
