Name:
Student ID #
First Name
Last Name
Middle Initial
Phone
Luther Email

Present Address:
Zip Code
Address
City State
Degree Program
Complete Name and Age of Each Family Member who will be living with you:
1.   2. 
3.   4.  
Do you have any special housing needs (i.e documented conditions including physical limitations, related allergies, etc.):
Pets:       Type:
Some pets are permitted with pre-approval. Limit of two (2) pets per apartment. Please contact the housing office.

Type of Student Housing Requested
First Choice
Second Choice
Third Choice

Date Housing Needed
    From:  To:
    Effective Date of Rental:

(Please check both if needed.)

Students who intentionally or knowingly falsify a housing application will be deemed ineligible for future Luther Seminary housing and could be asked to vacate current Luther Seminary housing.