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Home Address
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Street Address
Address 2
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State
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Birthday
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MM slash DD slash YYYY
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Phone
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BYU-I Email
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Personal Email
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Gender
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Male
Female
Are you currently 18 years or older?
*
Yes
No
Do you have any allergies or other disability that would prevent you from living with an assistance animal?
*
Yes
No
Please explain
Semester / Year
*
Winter 2025 (1/6/25 - 4/12/25)
Spring 2025 (4/18/25 - 7/26/25)
Fall 2025 (9/12/25-12/19/25)
Apartment Layout Mens
Select One
3 Bedroom x 3 Bath (Sold Out-Join Waitlist)
4 Bedroom x 4 Bath Flat (Sold Out-Join Waitlist)
4 Bedroom x 4 Bath Standard Townhome (Sold Out-Join Waitlist)
4 Bedroom x 4 Bath Oversized Townhome (Sold Out-Join Waitlist)
Apartment Layout Womens
Select One
2 Bedroom x 2 Bath Standard
2 Bedroom x 2 Bath Oversized
3 Bedroom x 3 Bath
4 Bedroom x 4 Bath Flat
4 Bedroom x 4 Bath Standard Townhome
4 Bedroom x 4 Bath Oversized Townhome
Roommate Request (Optional)
Second Semester (optional), $50 off both leases
None
Winter 2025
Spring 2025
Fall 2025
Please only select this option if you are wanting to sign for multiple semesters. If selected, your second semester will qualify you for $50 off each lease
Emergency Contact
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First
Last
*Must be a legal guardian if you are under 18*
Emergency Contact Phone
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Emergency Contact Email
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Rexburg Lodge
(208) 356-5638
[email protected]
538 S 2nd West Rexburg, ID 83440
Mon - Fri: 9:00 AM-5:00 PM
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