SUNY Adirondack Housing Application

Parent Information

Does the following definition apply to you at all? *

An independent student is one of the following: at least 24 years old, married, a graduate or professional student, a veteran, a member of the armed forces, an orphan, a ward of the court, someone with legal dependents other than a spouse, an emancipated minor, or someone who is homeless or at risk of becoming homeless.

Yes

Parent / Guardian First Name

Parent / Guardian Last Name

Parent / Guardian Mailing Address *

Country

Street

City

Region

Postal Code

Parent / Guardian Phone Number

Parent / Guardian Email Address

Acknowledgment

To successfully process my housing application, I understand that SUNY Adirondack, the Adirondack Housing Association, LLC, and the Faculty-Student Association of SUNY Adirondack will share certain biographic and financial information with each other. By submitting my completed application, I approve and authorize this information to be shared.

By signing my name to this application, I warrant that all statements are true and correct to the best of my knowledge. Submitting false information or withholding information may constitute fraud. By my signature I understand and accept the terms and conditions of the housing contract and agree to accept responsibility for the financial obligations incurred.

Student Acknowledgment *

By checking this box, I agree to the terms of the housing application.

Parent / Guardian Acknowledgment (if applicant is younger than 18) *

By checking this box, I agree to the terms of the housing application.

In place of your signature, please type your full legal name:

Friendly reminder, do not forget your housing deposit.