Housing/Commuter Form

Please verify the following information is correct. If there is a mistake in any of the information, please contact Lori Etheridge, Director of Residence Life, at 270-852-3284 or [email protected]


Demographic Information


Home Address:


Home Phone:    Cell Phone:  

Birthdate:      Gender:      Married:  


Student Information

Major:       Enrollment Status:        Enrolling in:  

Do you plan to participate in an NCAA sport?  


Housing Information


If you plan to live on campus, please verify that the following information is correct.

I have requested a roommate  

My resident Hall preference is  

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.  

If I have a chronic condition or physical limitation that warrants special housing considerations,  I did attach a physician’s letter to the Housing/Commuter Form indicating the type of accommodations I need.    

I have completed the Residential Student Questionnaire (the second page of the Housing/Commuter Form.)    



Leave this empty:

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Signature Certificate
Document name: Housing/Commuter Form
Unique Document ID: eee1f81169d29f3d4991b864f6a4fe3d9360f2d7
Timestamp Audit
May 17, 2017 8:15 am CDTHousing/Commuter Form Uploaded by C Bryan Blount - [email protected] IP
March 2, 2018 3:19 pm CDTLori Etheridge - [email protected] added by C Bryan Blount - [email protected] as a CC'd Recipient Ip: