Student ID:___________________ SSN:________________________ Male____ Female____

Date of Birth: __________________ Credit Hours Completed as of Spring 2001: ________________

Current Local Address:_____________________________________________________________________
                                                     Street

______________________________________________________________(_____)______________
City                                                                        ST                          Zip                                   Phone

Permanent Address:________________________________________________________________________
                                                   Street

______________________________________________________________(_____)______________
City                                                                        ST                          Zip                                   Phone

Session I only ____                                              Session II only ______                                    Both Session I & Session II _______
(May 21-June 30)                                                    (July 1-August 11)
 

If the term dates of your classes are different then these dates, please indicate the course and the dates:

________________________________________________________________________________________

Roommate Preference: ____________________________________________________________________
Roommate preferences must be mutual.

If available, would you prefer single room? Yes _______ No ________
There is an additional charge for a single room accommodation. Single rooms are granted as space permits.

Please check all that apply:

_____ I usually listen to music while studying                                       _____ I am an "early morning" person

_____ I am interested in living with a student from                                 _____ I am a "late night" person
         another country.

Terms of the Housing Agreement:

The summer school agreement is for the entire summer session(s) as indicated above. If your particular program dates are different than the full session dates
you MUST indicate this information above. The University will endeavor but cannot guarantee to assign space according to the preference indicated.
Assignments are made without regard to race, color, or national origin. Students applying for summer housing must have an active housing deposit on file, or
must submit a $100 deposit with this form to the Finance Office. The Housing Agreement is a binding contract that obligates the student to live in University-
operated residence halls for the full term or remainder thereof, as indicated by the student on this form. In case of cancellation of room reservations refund of
charges and deposit will be as follows:

1) 100% Deposit refund if written notice is received by the Office of Residential Life and Housing by May 1^st for Session I and June 1 for Session II.
2) 50% Deposit refund if written notice is received by the Office of Residential Life and Housing by May 18^th for Session I and June 30^th for Session II.
3) The Housing Agreement may not be cancelled after May 21^st for Session I and July 1^st for Session II unless the student withdraws from summer
    school courses.

I hereby certify that I understand and accept University housing regulations concerning assessments and refunds and that I will comply with University
regulations found in the 2000-2001 Terms and Conditions for Residence Hall Housing, University Catalog, Student Guide to University Life, and other official
publications.

Signature of Student: ________________________________________________________ Date: ________________