Residence Life

For new students, after your on-line application is received, you will receive a confirmation letter with a copy of the Campus Housing Agreement to be signed and returned to the Office of Residence Life and Housing. Students WILL NOT be assigned to campus housing until the Campus Housing Agreement is received. Returning students will complete the Campus Housing Agreement during the lottery process. Date  11-21-09
First Name:
Preferred Name or Nickname:
Middle Name:
Last Name:
*Given/Family Name
Gender:
Student Status: (Required)
Class Level:
(2009-2010 Academic Year - Required)
I am an International Student: Yes No
I am a recruited Capital University student athlete. Yes No

If yes please tell us which sport:

Ethnic Background:
Enrollment Term:
Capital University
ID #:		  
Email:  
Home
Telephone:		 ( )  (Area code and Phone number (XXX) XXX-XXXX)
Cell Phone ( ) (Area code and Phone number (XXX) XXX-XXXX)
Birthdate: (MM-DD-YYYY)
 
Permanent Home Address
City, State, Zip
City State ZIP
 

* If address is international please enter it here:
Emergency Contact Person
Emergency Contact Relationship:


(father, mother, spouse etc.)
Emergency Contact Phone: ( ) (Area code and Phone number (XXX) XXX-XXXX)
International Emergency Contact Phone:
 
1. I am a:
  Non-smoker will not room with smoker
Smoker
Non-smoker will room with smoker
2. I go to sleep:
  Early Evening
Late Evening
No preference
3. Study Habits:
  I prefer quiet study time
I prefer music playing when I study
I like to watch TV when I study
Nothing distracts me
No preference I am flexible
4. I like to live in a room that is:
  Very neat
Reasonably neat
Probably on the messy side
5. In my room I like to have:
  Private time
The occasional guest
People around frequently
No preference
6. Do you already have a roommate preference (requests must be mutual):
Requests must be mutual and received in writing by June 15th. Yes
No
7. If yes, please provide name of roommate (last name, first name, middle initial - you may list up to 5 individuals):
 
8. If you are an eligible Honors Student, would you prefer to live in Honors Housing? The Honors progam is open to students with a 26 ACT or 1170 SAT. The Honors Program provides living space for honors students for weekly gatherings, seminars and cultural enrichment.
  Yes
No
9. Do you have any physical (or other) needs that will require special accommodations?” Residence Life and Housing must receive documentation for all special accommodations in writing before June 15th. Please use the following documentation guidelines
  Yes No
10. I would like to be placed in a single. Please not - single rooms have a higher Room Rate and are available on a first come, first serve basis. Priority will be given to those students with a documented need.
  Yes No
11. Would you be interested in being housed on a floor with other students in your intended major?
  Yes No If yes please tell us your intended major
  Intended Major:
12.

Would you be interested in being housed on a "Healthy Choices" floor with other students? Students living on a healthy choices floor will receive targeted programming on academic, personal, an interpersonal wellness topics. Students living on a healthy choices floor will sign a contract committing to live substance (alcohol, tobacco, and other drugs) free.

Yes No
   
13. Is there any other information that Residence Life & Housing needs to know in order to process your application