Date Submitted:  04-19-2024

All information with an red label is required.

Applicant Information

Permanent Home Address

Yes  No

I understand that all applicants are subject to a criminal background screening. I hereby consent and authorize Campus Housing at ICC to complete this criminal background screening.


Enter 9 numbers Only - no dashes or spaces.
E-mail Address
If you are a current student, please provide your email address.
Choose the email address you prefer to receive information:

Housing will use the e-mail provided to contact you during the application process. Please check your email regularly.

School Information

Emergency Contact Information


Roommate Information

If possible I would prefer these roommates (max of three).

If possible, I would like to be assigned to:

1st Choice:   
2nd Choice: 


The following information will be used for roommate referrals only. Please complete this section as if you were talking to a prospective roommate and keep in mind that your honesty will benefit both you and your roommates. Check all items that apply.


On most weeknights I             
On most weekends I               


I prefer to study in the morning  I prefer to study in the afternoon  I prefer to study at night
Where I Study I prefer to study in my bedroom  I prefer to study in the living room  I prefer to study at the library
I study less than 1 hour/day  I study 1-3 hours/day  I study more than 3 hours/day

I need complete quiet I can have some noise Nothing will distract me
I need complete quiet I can have some noise Nothing will distract me

Other people consider me to be

Immaculately Clean [1]
Very Messy [5] Your selection:
Extremely Quiet [1]
Really Outgoing [5]     Your selection:
Morning Person [1]
Night Person [5] Your selection:

Special considerations:

I give permission to release my contact information and roommate matching preferences to prospective roommates.

Terms and Conditions

Applicant represents all of the above information is true, complete and authorizes the verification of same by reasonable means. Any misrepresentation or omission may be cause for the rejection of this application and/or termination of this lease. Applicant further authorizes free exchange of information between Illinois Central College and Capstone On-Campus Management, including but not limited to the applicant's student status, academic records, judicial records, and financial records to be used to determine whether this applicant shall be approved or disapproved.

Applicant understands the administration fee of 100.00 is non-refundable and non-transferable.

Applicant understands that a financially responsible Guarantor over the age of 21 is required for all applicants under the age of 18 for the completion of the application process, and that failure to provide a Guarantor may result in cancellation of this application and any resultant lease.