Residency Information Form This form must be completed by all students. Please complete this form as early as possible. Deposit* I have made my enrollment deposit to Kentucky Wesleyan College Please note, you must make your enrollment and/or housing deposit(s) to Kentucky Wesleyan College prior to submitting your Residency Information Form. Name* First Middle Last Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands My Email* My Cell Phone*Home PhoneBirth Date* MM slash DD slash YYYY Gender Male Female Are you married? Yes No Prefer Not to Answer The next set of information, Emergency Contacts, will be used if you have an emergency situation while on campus or at a College sponsored event. Emergency Contact Status* I do have an emergency contact I do not have an emergency contact Emergency Contact Name* Emergency Contact's Relationship to Me*ParentSpouseChildRelativePartnerFriendOtherEmergency Contact's Phone Number*The remainder of this form will ask for information related to your academic, residential, and extra-curricular interests.Please list your academic major interest(s). Are you participating in an athletic team? If so, which sport? What is your enrollment status?*FreshmanSophomoreJuniorSeniorTransferI Plan to Enroll in*Fall SemesterSpring SemesterPlease let us know if you: Plan to live in a Kentucky Wesleyan College residence hall. Plan to commute from home. Residential Student QuestionnaireYour new home at Kentucky Wesleyan College will be friendly and inviting, and we want to ensure compatibility between you and your new roommate. To help make the best possible housing assignment for you, the Student Services needs the following information. What is your housing preference?*Community StyleSuite StyleAre you interested in living in themed housing?*Not Interested/No PreferenceFirst Year LivingDigital Domain (Online Gaming Community)Greek LifeI request my roommate to be: Tell us how tall you are. (Not all our halls have XL mattresses.) Tell us about the hours you keep: I tend to be a night owl (stay up late, get up late). I tend to be an early bird (go to bed early, get up early). I like to sleep with music or the television on. I like to sleep in silence. Tell us about your study habits: I prefer to study in a quiet room. I prefer to study with music or the television on. I prefer to study with music or the television on. I tend to cram the night before an exam. Tell us if you agree with the statements below: I believe roommates should be able to borrow items when needed (clothes, food, movies, etc.) I am good at remembering messages and passing them along to others I am often forgetful and do not remember messages. I keep a clean room. I am more likely to talk about problems with my roommate to work them out. I am more likely to keep problems with my roommate to myself. If possible, I would like to room with someone with the following interests:Over Winter Break, our campus closes. This prohibits students from staying on campus unless they are in approved Break Housing. Will you need Break Housing?YesNoExamples of students who may need this include Basketball Players and International Students not returning home.I understand that I am providing my housing preference and that my room assignment will be made based on date of deposit and completion of my Housing Application. Providing my preference does not guarantee my housing assignment.* I have read the above disclaimer. Special Needs:If you have a chronic condition or physical limitation that warrants special housing considerations, please attach a physician's letter to this form indicating the type of accomadations neededAttach Physician's LetterMax. file size: 50 MB.