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Applicant Name:

Social Security Number:

Date of Birth (specify mo/day/year):

Degree Program:

International Student: Yes No

Gender: Male Female

Housing is needed beginning with which semester:

Fall Spring Other (Semester/Year)

Will you be a Commuting Student? If YES please disregard this application and fill out a Commuter Housing Application. This also can be obtained by requesting one from Single_Housing@asburyseminary.edu.

Are there any health concerns that should be taken into consideration in regards to housing? (Please list and attach a doctor's note to this application)

Please supply the Following Addresses:

1. Present Mailing Address
Street:
City: State: Zip:

Phone: E-Mail Address:

2. Temporary Mailing Address
Street:
City: State: Zip:

Phone: E-Mail Address:

Housing Needs
Indicate below your FIRST choice. Receipt of this form and deposit places you on a waiting list but does not guarantee assignment.

MEN’S RESIDENCE HALL: Newton Grice Larabee-Morris

WOMEN’S RESIDENCE HALL: Orlean House

Additional Questions
Please check an answer for each of the following questions.

1. When do you spend the most time studying? :

Morning Afternoon Evening

2. Can you listen to music while you study? :

Yes No

3. Where do you prefer to study? :

Dorm Room Library Other

4. What time do you generally go to bed? :

9-11 p.m. 11-1 a.m. 1-2 a.m.

Other

5. What time do you usually wake up on a weekday morning? :

6-8 a.m. 8-10 a.m. 10-noon

6. Indicate your level of neatness.
1 (Very Neat) 2 3 4 5 (Very Messy)

Can you live with a little disorder? :

Yes No

7. Do you watch television in the room during the day? :

Yes No

PLEASE KEEP THE HOUSING OFFICE NOTIFIED OF ANY CHANGE OF ADDRESS. THANK YOU!

NOTE: YOU MUST HAVE A MINIMUM OF 9 CREDIT HOURS IN THE FALL AND SPRING SEMSTERS TO QUALIFY FOR SEMINARY HOUSING. ONCE BOTH THE APPLICATION AND HOUSING DEPOSIT ARE RECEIVED YOU WILL BE PLACED ON A LIST (IN ORDER OF FIRST COME FIRST SERVE) OF THOSE SEEKING RESIDENTIAL HOUSING.

Please read and sign below
I understand that this is a contract. I hereby enclose my "housing application deposit" of $100. I understand that after my housing application and deposit have been received this places me on the priority list, but without guarantee of assignment. I also understand that this deposit will become part of the security/damage deposit when I occupy Seminary housing. If Seminary housing is not available for the term specified above and I do not wish to remain on the priority list for future assignment, I may request a refund. If I accept, but then decline, the Seminary housing offer, or if I do not show up for my reservation, then the deposit is forfeit. I also understand that if I have requested a double occupancy room and my roommate does not show for his/her reservation, the Seminary may ask me to change rooms with someone of similar circumstance.

Date:

Applicant Name: