SUPPLEMENTAL RENTAL APPLICATION FOR NON-U.S.

CITIZENS
Each co-resident and each occupant 18 years old and over who is not a U.S. citizen
must submit a separate application. Spouses may submit a joint application.

e are re estin o to fill o t this S pplemental ental Application beca se o ha e in icate that o are not a .S. citi en. e are as in
all applicants ho are not .S. citi ens to fill o t this form. e are committe to compliance ith fair ho sin la s an o not iscriminate
base on race, color, reli ion, se , national ori in, han icap or familial stat s. he p rpose of this form is
1. to i e o the option to f rnish information abo t an emer enc contact person for o in o r home co ntr
2. to erif that o are la f ll in the nite States
. to etermine hether o r ri ht to be in the .S. e pires rin o r ease Contract term an
. to enable s to better cooperate ith o ernment officials in the performance of their ties, hen re este .
e on t anticipate sharin this S pplemental Application ith an one e cept o ernment officials ho mi ht in ire abo t o .

ABOUT YOU o r f ll name (exactly as on any card or document YOUR SPOUSE o r f ll name (exactly as on any card or document
issued by U.S. Citizenship and Immigration Services): issued by U.S. Citizenship and Immigration Services):
_______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________

o r place of birth. Please indicate the city, state (region, province, etc.) o r place of birth. Please indicate the city, state (region, province, etc.)
and country: ________________________________________________________________ and country: ________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________

Co ntr or co ntries of hich o are a citi en (list all): _____________ Co ntr or co ntries of hich o are a citi en (list all): _____________
_______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________

Appro imatel ho lon ha e o been in the nite States Appro imatel ho lon ha e o been in the nite States
ears __________________ onths __________________ ears __________________ onths __________________

a e o e er been as e or or ere b a representati e of an a e o e er been as e or or ere b a representati e of an

o ernment to lea e the .S. or an other co ntr q es q No o ernment to lea e the .S. or an other co ntr q es q No
If es, please state hen an hat co ntr or co ntries (list all) If es, please state hen an hat co ntr or co ntries (list all)
_______________________________________________________________________________ _______________________________________________________________________________
_______________________________________________________________________________ _______________________________________________________________________________

erson in o r home co ntr hom e ma contact in e ent of an
emer enc (optional). Name _____________________________________________
elationship _______________________________________________________________
ailin a ress ___________________________________________________________
_______________________________________________________________________________
mail a ress _____________________________________________________________
hone _______________________________________________________________________
erson in o r home co ntr hom e ma contact in e ent of an
emer enc (optional). Name _____________________________________________
elationship _______________________________________________________________
ailin a ress ___________________________________________________________
_______________________________________________________________________________
mail a ress _____________________________________________________________
hone _______________________________________________________________________

lease chec the .S. Citi enship an Immi ration Ser ices SCIS lease chec the .S. Citi enship an Immi ration Ser ices SCIS
oc ment that entitles o to be in the nite States oc ment that entitles o to be in the nite States

q Form I 1 ermanent esi ent Car Alien e istration eceipt q Form I 1 ermanent esi ent Car Alien e istration eceipt
Car form incl es photo an fin erprint . Car form incl es photo an fin erprint .
Car n mber __________________________________________________________ Car n mber __________________________________________________________

q Form I mplo ment A thori ation oc ment form incl es q Form I mplo ment A thori ation oc ment form incl es
photo an fin erprint . photo an fin erprint .
piration ate _______________________________________________________ piration ate _______________________________________________________
Car n mber __________________________________________________________ Car n mber __________________________________________________________

q Form I lobal ntr Form form oes not incl e photo or q Form I lobal ntr Form form oes not incl e photo or
fin erprint . piration ate ________________________________________ fin erprint . piration ate ________________________________________
Form N mber _________________________________________________________ Form N mber _________________________________________________________

q SCIS receipt for replacement of one of the abo e oc ments, ith q SCIS receipt for replacement of one of the abo e oc ments, ith
erification b SCIS of o r entitlement to the abo e. erification b SCIS of o r entitlement to the abo e.

If you are relying on Form I-94, we will ask to see your passport and visa,
and you will need to answer the questions below.
Co ntr iss in o r passport __________________________________________
o r passport n mber _________________________________________________
piration ate _________________________________________________________
If you are relying on Form I-94, we will ask to see your passport and visa,
and you will need to answer the questions below.
Co ntr iss in o r passport __________________________________________
o r passport n mber _________________________________________________
piration ate _________________________________________________________

o o ha e a isa q es q No o o ha e a isa q es q No
If es, hat t pe q st ent q or q isitor q other If es, hat t pe q st ent q or q isitor q other
(specify): (specify):
____________________________________________________________________________ ____________________________________________________________________________
isa e piration ate ____________________________________________________ isa e piration ate ____________________________________________________

Applicant s si nat re ______________________________________________________

We may ask to make a photocopy of any of the USCIS documents
checked above and, if needed, your passport and visa. Spo se s si nat re _________________________________________________________

Date __________________________________________________________________________

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