Kansas Wesleyan University :: Residence Hall Application

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Residence Hall Application

Today's Date: Please use the MM/DD/YYYY Date format (07/18/2006)
Semesters you plan on attending KWU: Fall 2008 Summer 2008
Full Name: First: Middle: Last: Maiden Name:
Permanent Address: Street: City: State: Zip:
Home Phone: Cell Phone: Email Address:
Classification: Freshman Sophomore Junior Senior Intended Major:
Gender: Male Female Birthdate: Age:
Please list the CAMPUS ACTIVITIES you plan to be involved in:

EMERGENCY CONTACT INFORMATION
In case of an emergency, we should contact: Name:
Address: City: State: Zip: Phone:
Relation to you:

IF YOU ARE SINGLE AND UNDER THE AGE OF 21, YOU ARE REQUIRED TO LIVE ON CAMPUS OR WITH A PARENT OR GUARDIAN. PLEASE COMPLETE THE FOLLOWING IF YOU DO NOT PLAN TO LIVE IN THE RESIDENCE HALL
Name:
I will be living with my immediate family at the following address: Address: City: State: Zip:
I am 21 or older and will be living off campus. My local address will be: Address: City: State: Zip:
I am 21 or older and interested in living in a campus apartment, please send me information: Yes No
If you don't know what your address will be at this time, please contact the Office of Student Life as soon as you know.

RESIDENCE HALL INFORMATION
Roommate Preference: (Both individuals must mutually request this arrangement)
Residence Hall Preference: Males: Wesley Hall Females: Pfieffer Hall Wilson Hall (option for transfer students only)
Type of Room Wanted: Private Double Occupancy

PERSONAL LIFESTYLE (please select the most correct response - this information will help us match you with a compatible roommate)

Religious Denomination: Do you attend church?: Regularly Occasionally Never
Do you drink?: Yes Occasionally Never Do you: Wake Up Early Stay up Late
Do you smoke?: Yes Occasionally Never Do you object to a roommate who smokes: Yes no There is a no smoking policy in any university building
Do you study?: A lot A little To Music With Friends Do you watch TV?: A lot Occasionally Never
Is your room: Always Neat Occasionally Clean A Mess
What is your sibling rank: Youngest Middle Child Oldest Only child
What type of music do you listen to the most: Alternative Christian Classical Country Dance R&B Rap Rock Top 40 Other:
Hometown Population: High School Name: # of Students:
Are you a transfer student: Yes no Previous College: # of Students: