VLS HOUSING INFORMATION FORM

LANDLORD or Contact Information:
                                                                               Vermont Law School
                                                                               Housing Office
Last Name:                     First Name:                                     PO Box 96
_______________________________________________                                S. Royalton, VT 05068
                                                                               Tammie Johnson 802-831-1261
If you submit more than one rental, address info only required on one form
______________________________________________                                       For Office Use Only:

______________________________________________                                     Date Entered: _______
City                    State             Zip                                      Check  Cash 
                                                                                   Credit Card 
                                                                                   Paid: ________
Email Address:___________________________________

Phone: Home: ________________ Work: ____________ Cell:___________
List only numbers which students can call

PAYMENT: Total Number of Rentals: ______ Total $ Amount Enclosed: ___________
$25 to register, includes one free rental; $10 for every additional rental.


Street address: _________________________________ Town:_________________
Distance to VLS: □ Walk to VLS    □ 1-2 miles □ 2-5 miles □ 5-10 miles □ more than 10 miles

Driving time to VLS: __________ Minutes

Date Available: __________________           Lease Term: 9 months    12 months     Negotiable

(Circle One)
Property Type:        Utilities Included     Furnished     Internet Access        Smoking:
House                    Yes       No        Yes    No     DSL      Wireless      Yes    No
Apartment                   Partial           Partial      Cable    Dialup        Negotiable
Shared                     Negotiable        Negotiable    Satellite None

Pets: Yes No Negotiable Comments:

# of Bedrooms: _____             Rent: $___________/month
Additional Comments or Description (a few lines; add any information not included above)

Landlords, take note:

- Please be advised that Vermont Law School does not accept responsibility for matters between the landlords
and tenants who use our list. Vermont Law School reserves the right to amend information on the housing list
as we feel it best meets student needs.

- Failure to comply with state housing codes will result in your rental listing(s) being removed from the VLS
Housing website. Contact the VT Dept of Public Safety and ask for their brochure "What Landlords Need to
Know About Safe Housing and Complying with the Law" or go to www.dps.state.vt.us/fire/ and click on

- By signing this form (or submitting the form online) you signify that the following statement is true:
"I certify that I provide and maintain premises that are in compliance with all applicable housing codes (see
Vermont Statue, Title 9 Chapter 137)."

________________________________________________                            _______________________
Landlord Signature                                                          Date

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