Online Campus Housing Application

Enter Your Personal Information
Social Security #
Date of Birth
Gender	FemaleMale
First Name
Middle Name
Last Name
Address
Apt.
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Home Phone
Cell Phone
Email
Step 1 of 5

Enter Emergency Contact Information
First Name
Last Name
Address
Apt.
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Home Phone
Work Phone
Relationship
Step 2 of 5

Enter Your Vehicle Information
Make
Model
Year
Color
License Plate #
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Step 3 of 5

Criminal History
Have you ever been convicted of a felony?	NoYes
If yes, please describe:
Step 4 of 5

Reservation / Preference Information
Reservation For	Year:   FallSpring
Educational Objective	Certificate 2 Year Degree 4 Year Degree
Major
Roommate Preference
Hobbies / Interestes
I understand that my application is not complete until I submit the following:
Deposit/Fees $175 Received by Housing Office
Physician's Report for General Physical
I have read the law concerning bacterial meningitis
Step 5 of 5

Submission Status