Contact Information

Name:

 

 

Address:

 

City:

 

State:

 

Zip Code:

 

Home Phone Number:

     xxx-xxx-xxxx  
Cell Phone Number:      xxx-xxx-xxxx
Date of birth:      xx/xx/xxxx  

Email Address:

     
Gender:
Ethnic Origin (Optional):
Emergency Information

Father/Guardian:

Home Phone Number:

Work Phone Number:

Address:

City:

State:

Zip Code:

 

Mother/Guardian:

Home Phone Number:

Work Phone Number:

Address:

City:

State:

Zip Code:

My degree interests are:

First Choice:

 

Second Choice:

Third Choice:

Misc Information

List any hobbies or interests to help with roommate pairing (Sports, Music, Games, etc.):

 

Describe your personality briefly. (shy, outgoing, late night person, early riser, conservative, liberal):

All facilities are non-smoking; however some people prefer to be roomed with those who don't smoke. Please select one.

 

Would you be willing to room with someone who smokes?

 

Do you have any chronic ailments or physical disabilities which could affect room assignment?

If yes, please describe:

 

I plan to begin classes in:   of (year)  
Class:
Room Preference:
Will you be participating in a varsity sport, cheer, dance, or band? If so, which one:
Do you have any preferences regarding roommate and/or suitemates?
If yes, please state preferences or names:

 

Please understand that specific roommates requests or preferences are only guaranteed if the applications and deposits have been received by May 1.

 

Form Submission
Both the Tuition and Dorm Deposits must be paid before housing assignments are made!

Fall deposits recieved after May 1st and Spring deposits received after Dec. 1st are non-refundable. Any refund request must be in writing and postmarked no later than May 1st for the Fall and Dec. 1st for the Spring.

All freshmen and sophmores that live further than a fifty mile radius of campus must live on campus.

If you encounter difficulties, please contact the Admissions office at 1-800-937-2448 ext. 2205