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Contact Person *
Contact Person Email
Contact Person Phone *
Rental Address *
Landlord Name & Address
Phone
check one *	Apartment House Basement Studio Room Sublet Specify your own value:
Rent per month
Deposit Required
Date available	Date available Date
No. of bedrooms
No. of Baths
Included in your rental	Heat Washer Hardwood floors Electricity Dryer Air conditioned Stove Laundry Hookups Off-street parking Refrigerator Fire Alarm System Garage Dishwasher Security System Pets allowed Please check any of the following that are included in your rental
I prefer to rent to	Non smokers Women only Graduate students Faculty/staff Men only Undergraduates
Pertinent Information	List any other pertinent information that you would like published
Signature *
Date *	Date Date By signing this document, I allow the Worcester State University Student Activities Office to release and/or post the information provided. Worcester State University is not liable for any circumstances related to the off-campus housing or roomate list. I understand that Worcester State University is strictly a source of communication and shared information between property owner and tenants, and is not party to arrangements made between property owners and tenants.
Date Received	Date Received Date
Date Published	Date Published Date
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