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Applicant Name:

Social Security Number:

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

Gender: Male Female

Housing is needed for which mini term:

January Summer 1 Summer 2 Summer 3

Housing is needed beginning with (month/day/year)
and ending (month/day/year).

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:

Street:

City:

State:

Zip:

Telephone Number:

E-Mail Address:

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

NOTE: You may have a roommate and/or the previous tenant's belongings may still be in the room due to them returning for the following semester. Therefore, only bring the essentials. Here is some important information to know:
* You will need bedding for a single twin bed – (Men) extra long sheets (Women) twin sheets fit best.
* You will need towels.
* The cafeteria is open in January, but not open in the summer, but there are refrigerators, microwaves, and stove tops on each floor. There is a local grocery store and a few sandwich shops/small restaurants in Wilmore.
* When you arrive you need to pick up your room keys and Check-In/Out form at the Beeson Manor.
* Prior to leaving the residence hall, you will need to check out with the RA on duty, again call the RA cell phone, # listed above.
* Prior to leaving it is your responsibility to clean up your living space. This includes taking out trash, washing off desks and dressers, and vacuuming the floor. Please also do your part to keep the bathrooms clean. If rooms are left in an unsatisfactory condition a charge will be placed on your student account.
* If you are flying in and need picked up at the airport contact Beeson Manor and they will assist you. Phone # 859-858-2156. There is a fee for this service!

Please read and sign below.
I understand that this is a contract. I understand that after my application and deposit have been received this places me on the priority list, but without a guarantee of assignment. Housing is granted on a first come first serve basis. A deposit of $50 must be received before one can be considered for housing. I will notify the single housing office immediately of any changes to the length of my stay prior to the time of my arrival. Cancellation Policy: Single Housing must be informed 30 days prior to arrival in order for the housing deposit to be refunded.

Date:

Applicant Name: