Secure Program Application

Please fill out this form COMPLETELY and sign where indicated.

Program ID Number

COLLEGE INFORMATION

Class Standing

Credit Load
PERSONAL INFORMATION
Marital Status
Is your present rent up to date?
Was your rent up to date?
VEHICLE INFORMATION
EMPLOYMENT
INCOME
Proof of Income
Proof of Income
Proof of Income
FINANCIAL INFORMATION
EMERGENCY / PERSONAL REFERENCES
APPLICANT QUESTIONNAIRE
Has applicant ever been sued for bills? Has applicant ever been locked out of their apartment by the sheriff?
Has applicant ever been bankrupt? Has applicant ever been brought to court by another landlord?
Has applicant ever been guilty of a crime? Has applicant ever moved owing rent or damaged an apartment?
Has applicant ever broken a Lease? Is the total move-in amount available now (program fee and deposit)?

Authorization

Applicant authorizes MOCA Spot LLC to contact past and present landlords, employers, creditors, credit bureaus, neighbors and any other sources deemed necessary to investigate applicant. All information is true, accurate and complete to the best of applicant’s knowledge. MOCA Spot LLC reserves the right to disqualify student if information is not as represented. ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME. By entering your first and last names, you electronically authorize as specified in the above document.

By entering your first and last names, you electronically authorize as specified in the above document.

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