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@example.com
Home Phone: Cell Phone:
Birthdate: Gender: Married:
Major: Enrollment Status: Enrolling in:
Do you plan to participate in an NCAA sport?
If you plan to live on campus, please verify that the following information is correct.
I have requested a roommate YesNo
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 attached the doctor’s letterI did not attache the doctor’s letterI do not need special accomodations
I have completed the Residential Student Questionnaire (the second page of the Housing/Commuter Form.) YesNo
Leave this empty:
If you have questions about the contents of this document, you can email the document owner.
Document Name: Housing/Commuter Form
Agree & Sign