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Legal Name
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First
Last
Home Address
*
Street Address
Address 2
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State
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Birthday
*
MM slash DD slash YYYY
Social Security Number
*
Phone
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BYU-I Email
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Personal Email
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Are you currently 18 years or older?
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Enter your age
*
Please enter a number from
0
to
99
.
Do you have any allergies or other disability that would prevent you from living with an assistance animal?
*
Yes
No
Please explain
Semester / Year
*
Spring 2025 (4/18/25 - 7/26/25)
Fall 2025 (9/12/25-12/19/25)
Winter 2026 (1/5/26-4/11/26)
Parking Pass
No Parking Pass
Indoor: $199
Outdoor: $150
T-Permit: (For Trucks Longer than 200" in length) $199
Overflow: (Top of Parking Garage Where Uncovered) $125
Vehicle Make
Vehicle Model
Vehicle Color
Vehicle Year
License Plate Number
Vehicle State of Registration
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Alaska
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Tennessee
Texas
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Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Apartment Layout Mens
Select One
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
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 2026
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
*
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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