Apartment Condition Inventory (ACI) Form

This form is intended for students who are living on-campus for the fall of 2010 and arrive before the RA has checked in the apartment. The RA will fill out a paper Apartment Condition Inventory and you will have a chance to make an additions, but this form will allow you record any damage you see when you move in.

* denotes a required field.

Building & Room Number:

*Student ID #:

*Student Last Name:

*First Name:

MI:

* Email Address:

Cell Phone #:

Instructions! Note the general condition in all areas. Your RA will also go through your apartment, but please especially note if there is damage that will be covered by furniture or wall hangings. If there is no damage simply write "no damage".

Living Room - Note any damage to ceiling, floor, windows, couch, chairs, end tables, lamps, door, light fixtures and bookshelves.

Kitchen - Note any damage to ceiling, floor, cabinets, refrigerator, stove, oven, kitchen table, kitchen chairs, sink, counter, light fixtures or closet.

Bathroom - Please note any damage to ceiling, floor, cabinets, mirrors, medicine chest, shower, toilet, sink, counter, walls & light fixtures

Hallway - Please note any damage to ceiling, floor, walls, light fixtures and outlets.

Is the Accustat broken?

Yes No

If broken please describe:

Front Bedroom

Walls & Ceilings in front bedroom - Note any medium or large holes or marks

Door in front bedroom - Please note general condition

Floor in front bedroom - Please note medium or large stains or burns

Windows - Note any cracks or breaks.

Is SCREEN torn, bent or missing?

Yes No
If yes, please explains:

Beds & Mattresses in front bedroom - Note any tears or stains in mattress

Desks & Desk Chairs in front bedroom - Note if drawers do not work. Also note any medium or large scratches or stains on desk or chair

Dressers in front bedroom - Note if drawers do not work. Also note any medium or large scratches or marks on dresser

Bookshelves in front bedroom - Number of shelves?

Note any damage or major scratches:

Please note general condition of the closets in front bedroom:

Are the closet doors both attached?

Yes No

Back Bedroom

Walls & Ceilings in Back Bedroom - Note any medium or large holes or marks

Door in back bedroom - Please note general condition

Floor in back bedroom - Please note medium or large stains or burns

Windows in back bedroom- Note any cracks or breaks.

Is SCREEN torn, bent or missing?

Yes No
If yes, please explains:

Beds & Mattresses in back bedroom - Note any tears or stains in mattress

Desks & Desk Chairs in back bedroom - Note if drawers do not work. Also note any medium or large scratches or stains on desk or chair

Dressers in back bedroom - Note if drawers do not work. Also note any medium or large scratches or marks on dresser

Bookshelves in back bedroom - Number of shelves?

Note any damage or major scratches:

Please note general condition of the closet in back bedroom

Are the closet doors both attached?

Yes No

I have evaluted the conditon of the above apartment and it's furnishings. I accept responsibility for their care. As a member of the living area, I also accept responsibility for the condition and furnishings of my lounge, restroom, and other public areas until my check-out from the residence.

I Agree
I Disagree

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