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NEWS & EVENTS

2012-2013 Housing Application

2012-2013
Housing Application

New First Year and Transfer Students

After you have completed your online housing application, please print, complete, and mail or fax a copy of the Campus Housing Agreement to the Residence Life Office. Once we receive your on-line housing application and your completed copy of the Campus Housing Agreement (PDF), you will receive a confirmation letter via the email address you have provided.

Continuing Capital University Students

Students will complete the Campus Housing Agreement during the room selection/lottery process each Spring. Those returning students who do not participate in the room selection/lottery process should print, complete and mail or fax a copy of the Campus Housing Agreement (PDF) to the Residence Life Office.

Students will not be assigned to campus housing until the completed Campus Housing Agreement is received.

Required fields are marked with an asterisk.*

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First Name*	Middle Name	Last Name*
Nickname	Gender
Birthday [None]

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Permanent Home Address	Permanent City	Permanent State
Permanent Zip
International Address
Home Phone	Cell Phone
Email	Capital University ID Number

Student Status	Class Level
Intended Major	Enrollment Term*
Ethnic Background	International Student? Yes No
Recruited Athlete? Yes No
If Yes what Sport:

Emergency Contacts

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Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relationship

Please provide a confidential contact person to be notified within 24-hours of a determination that the student is missing as established by campus safety or local law enforcement. If the student is under the age of 18, the students parent/guardian will be notified.

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Use Emergency Contact
Missing Person Contact Name
Missing Person Contact Phone
Missing Person Contact Relationship

General Information

General Information
Smoker - I am a: Non-Smoker will not room with a smoker Non-Smoker will room with a smoker Smoker Note that all residence halls are non-smoking.	Sleep Habits - I go to sleep: Early Evening Late Evening No Preference

Study Habits: I prefer quite 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	Neat / Messy - I like to live in a room that is: Very neat Reasonably neat Probably on the messy side

Guest Preference - In my room I like to have: Private time The occasional guest People arround frequently No preference

Do you have a roommate preference? (requests must be mutual) Yes No	If Yes, name up to 5 potential roommates

Single Room Request? Yes No	Special Needs? Yes No

Additional Information

Cluster Housing
Cluster Housing Selection (New First Year Students Only):

Honors Cluster - Students living in the Honors Cluster will participate in gatherings, seminars and cultural enrichment in collaboration with the Honors Program. The Honors Cluster is open to students who apply and are accepted into the Honors Program.

Academic Cluster - Students living in an Academic Cluster will be housed on a floor with other students in their intended academic area of study and will receive targeted programming from their academic area.

Healthy Choices Cluster - Students living in the Healthy Choices Cluster will receive targeted programming on academic, personal, and interpersonal wellness topics. They will sign a contract committing to live substance (alcohol, tobacco, and other drugs) free. Please note, the Healthy Choices floor will be co-ed and house both first year and upperclass students.

Is there any other information that Residence Life & Housing needs to know in order to process your application:

Please only press Submit once. Processing may take a moment.