Application for Residence at Rice Graduate Apartments
1515 Bissonnet, Houston, TX 77005
713-348-GRAD
gradapts@rice.edu

Personal Data

First Name: Last Name

Gender: Female     Male

Current Local Address:
Line 1 (street, apt, etc)
Line 2 (city, state/province, zip/postal code)
Line 3 (country)

Current Telephone: (Please include country code if outside USA.)

Permanent Home Address:
Line 1 (street, apt, etc)
Line 2 (city, state/province, zip/postal code)
Line 3 (country)

Home Telephone: (Please include country code if outside USA.)

E-mail:

Birthday: Month Date Year

Driver's License State (If applicable)

The department I will enroll at Rice is

Emergency Contact Information

Parent/Guardian/Other Name

Phone Number

Address:
Line 1 (street, apt, etc)
Line 2 (city, state/province, zip/postal code)
Line 3 (country)

Please answer the following questions regarding to apartment application:

Do you have your own roommate?

Yes
No

If yes, please list each one below:
1.
2.
3.

If you need a roommate, please answer the following questions. However we are not allowed to honor roommate requests based on religion or nationality.

Do you smoke? Yes      No
Do you object to a roommate who smokes? Yes      No
Do you object to late study? Yes      No
Do you object to music while studying? Yes      No
Do you require a vegetarian roommate? Yes      No
Other concerns about your roommate

Please select the unit type you would like to live in and rank choices 1- 5 in order of preference in the boxes below.

4 Bedroom Unit - Semi Private Bedroom
2 Bedroom Unit - Private Bedroom
One Bedroom
Efficiency Large
Efficiency Small

What semester are you applying for?