Apartments are available for students of John A. Gupton College only. One month rental deposit of $500.00 and
completion of this rental application must be submitted before the college can place your name on the list for an
apartment. Rental deposits will be deposited 30 days prior to the semester start date into John A. Gupton
College. All cancellations must be made 30 days prior to the semester start date in order to receive a deposit
refund. Each apartment is to be occupied by one adult. No children are allowed. Domestic animals are not
permitted on or about the premises at any time.
Personal Information
Name of Applicant _________________________________ Telephone_______________________
Present Address_____________________________________________________________________
City_________________________ State__________ Zip Code________________
Automobile Make and Model___________________________ Year________ Color_____________
Tag Number___________________________ State Registered______________________________
Date of Birth__________________________ Social Security Number
Name of Parent or Spouse________________________________ Telephone_____________________
Present Address_______________________________________________________________________
City__________________________ State________ Zip Code_______________
Personal References
Name________________________ Relationship________________ Telephone________________
Name________________________ Relationship_________________ Telephone________________
Name________________________ Relationship_________________ Telephone________________
Disclosure Statement
I/We, the undersigned, understand that John A. Gupton College is the leasing agent and representative for the
owner/landlord and that the leasing agent’s fees will be paid by the owner/landlord. The undersigned
acknowledges that this written notice was received prior to the undersigned receiving a lease agreement.
RADON GAS - Notice to Prospective Tenant: Radon is a naturally occurring radioactive gas that, when it has
accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over
time. Levels of radon that exceed federal and state guidelines have been found in this state. Additional
information regarding radon and radon testing may be obtained from your county public health unit.
I/We, declare the foregoing information is true and correct, and I/We hereby authorize you to conduct an
employment and credit check and to verify our references.
_______________________________ ________ ___________________________ _______
Applicant Signature Date Co-Applicant Signature Date
Amt. of Deposit Received__________ Date Received_________ Semester/Year Move-in date___________ Apt.#________
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