Housing Contract for New Incoming Student

Academic Year: *

Academic Term: *

Fall/Spring

Fall Only

Spring Only

Section I: Personal Information

Last Name *

First Name *

Middle Initial

Preferred Name

Gender *

Birthday * +

Age *

Non-US Address? *

Yes

No

Street Address *

Address Line 2

City *

State *

State/Province *

Zip / Postal Code *

Country *

Home Phone Number *

Cell Phone Number *

Email Address *

Section II: Parents/Guardians Contact Information

First Name *

Last Name *

Relationship to student *

Please specify relationship: *

Non-US Address? *

Yes

No

Street Address *

Address Line 2

City *

State *

State/Province *

Zip / Postal Code *

Country *

Home Phone Number *

Cell Phone Number *

Email Address *

Would you like to add a secondary contact? *

Yes

No

First Name *

Last Name *

Relationship to student *

Please specify relationship: *

Non-US Address? *

Yes

No

Street Address *

Address Line 2

City *

State *

State/Province *

Zip / Postal Code *

Country *

Home Phone Number *

Cell Phone Number *

Email Address *