Platt's Lane Estates - Division of Housing and Ancillary Services at The University of Western Ontario

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Application for Housing

Please note: Offers of accommodation may be made by collect phone call. Ensure phone numbers are valid. Incomplete or incorrect telephone numbers will invalidate the application. All fields denoted by a * are required.

Details (Applicant)

Please provide some details regarding you, the applicant.

Title:

First Name:

Last Name:

UWO Student / Staff Number:

*
*
*
*

Gender:

Female Male *

Acedemic Information (Applicant)

If your a student please fill out the following.

Status:

Full-time *
Part-time

Faculty:

Current Year:

Details (Spouse / Partner / Roommate)

Please provide details regarding a spouse, partner or roommate (if any) that will be residing with you during your stay at Platt's Lane Estates.

First Name:

Last Name:

UWO Student#:

Contact Information (Current)

Please provide your contact information, all contact information is required.

Street Number:

Street Name:

City:

Province:

Postal Code:

Phone Number: (area code + number)

Alternate Number: (area code + number)

*
*
*
*
*
*
*

Email: *

Contact Information (Alternate)

Please provide additional contact information if you have an alternate address.

Street Number:

Street Name:

City:

Province:

Postal Code:

Phone Number: (area code + number)

Dependants under the age of 18

Please provide some details of any dependants under the age of 18 that will be living in the houshold during you stay at Platt's Lane Estates.

Dependant 1
Name:
Age:
Gender:

Female Male

Dependant 2
Name:
Age:
Gender:

Female Male

Dependant 3
Name:
Age:
Gender:

Female Male

Dependant 4
Name:
Age:
Gender:

Female Male

Choice of Accomodations

Please indicate your preference for the type of unit you will accept. The rank you choose for one option cannot be used for another. ie: if you rank a one bedroom apartment as your first choice, you cannot also rank a two bedroom apartment as your first choice. You may however rank any number as "not interested" as long as at least one option is ranked.

One-bedroom apartment

Two-bedroom apartment

Two-bedroom Town House

Three-bedroom Town House

Choose your preferred start date

Please note your preffered acceptance date, the date that you will assume financial responsibility. All leases begin on the first day of the month.

References

Your current/previous landlord will be contacted for a reference.

Landlord:

Address:

Phone: (area code + number)

*
*
*

Platt's Lane Estates Residents' Association

Would you like to receive the PLERA newsletter?

Yes No