| Date you plan to move in: |
Month
Day
Year(YYYY)
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| Name Prefix: |
Mr.
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| Last name: |
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| First name: |
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| Middle name: |
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Present Address
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Address: |
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City: |
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State/Province:
( if U.S. or Canada) |
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Zip/Postal code:
( if U.S. or Canada) |
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Country:
( if non-U.S.) |
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Phone number (with area code): |
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| Cell Phone (with area code): |
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Permanent Address
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Check if same as above
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Address: |
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City: |
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State/Province:
(if U.S. or Canada) |
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Zip/Postal code:
(if U.S. or Canada) |
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Country (if non-U.S.): |
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Phone number (with area code): |
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Personal Information
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Curriculum to which admitted: |
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Country of citizenship: |
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Birth date: |
Month
Day
Year(YYYY)
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Religious affiliation: |
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Gender: |
Male
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E-mail address: |
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Emergency Contact
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Contact name: |
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Phone number (with area code): |
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Preferences
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| All apartments are shared with either 3 or 4 occupants.
Single Occupancy = Occupant has their own bedroom.
Double Occupancy = Occupant shares bedroom with one other person.
Bathroom and common living areas shared in all apartments. |
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What is your bedroom preference? |
Single Bedroom preferred
Double Bedroom preferred
Single preferred, will accept double
Double preferred, will accept single
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Choice of Roommate: |
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How neat and clean do you keep your room? |
My room is ALWAYS neat and clean
My room is neat and clean MOST OF THE TIME
My room is neat and clean SOME TIMES
My room is NEVER neat and clean
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