Application Form

Boston University Medical Campus
Harrison Court Apartment Application 2009/2010
Online Applicants: Please complete the form below and press the “submit” button. The information will be sent directly to Susan Bamberg.
Paper Applicants: Please click here to download the application form in Adobe PDF format (you will need Adobe Acrobat Reader for this).  Complete the form and either mail or fax it to the contact information provided at the bottom of this page. *Please note availability is extremely limited.
Last Name:
First Name:
Email Address:
Date of Birth:

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/ 19

 (mm/dd/yyyy)
Social Security #:
Current Address Information:
Street Address:
City:
State:
Zip:
Phone #:
Permanent Address Information (if different from above):
Street Address:
City:
State:
Zip:
Phone #:
Apartment Information:
Type of Apartment Desired:

Number of Occupants:

Intended Start Date: (mm/dd/yyyy)

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Intended End Date: (mm/dd/yyyy)

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For more information on apartment types and current rent rates, please
refer to the “rental rates” page.
Please enter any additional information you wish to supply  below:
Affiliation:
Medical School Graduate School School of Public Health
Dental School Current Resident Other
Please indicate your current status (degree and year / position)
Contact Information:
Susan Bamberg
Email: sbamberg@bu.edu
Address: Harrison Court
Office of Rental Property Management
19 Deerfield Street floor 1
Boston, MA 02215		 Phone: (617) 353-4101
Fax: (617) 353-3737
Primary teaching affiliate
of BU School of Medicine