VC BASIC NEEDS OFFICE
4667 TELEGRAPH ROAD
VENTURA, CA 93003
Housing Referral Request Form
Please note: Ventura College and the Basic Needs Office offer this service to students to assist them with
their own search for suitable housing.
Check the box and sign below to acknowledge that Ventura College and the Basic Needs Office in no way:
• verify the identity of any person offering a place for rent
• inspect any housing
• make representation, guarantees, or promises with respect to the condition, quality, or safety of the property
• review any rental contracts, or make rental contracts
• endorse any property management company or landlord
• pay deposit, rent, or utilities
Full Name _____________________________________________________ Student ID # ___________________
Email Address _________________________________________________ Phone # ______________________
Check all that apply
How soon are you looking to
Month Day Year
What type of place are you
looking to rent?
Room Shared Room
Where do you want to live?
Santa Paula Other: ______________
How many people need
________ Adults (include yourself)
What is your monthly budget
What is your monthly budget for:
Utilities (Electric, Gas, Water, Sewage,
Do you need a home that is Handicap Accessible?
If yes, please specify what accommodations are
Do you have any additional requests or restrictions?
If yes, please list these in the comments section below.
Examples might include: pets; smoker; pet allergies; other
allergies or sensitivities
Please include anything you feel is of importance in a place/home to rent: __________________________
This form may be submitted by email to firstname.lastname@example.org
, or by fax to (805) 289-6383, or in person to the
Ventura College Basic Needs Office, located in the Bookstore and Campus Services (BCS) building.