Housing Profile Form for New Students

To reserve your space on-campus for 2013-2014, please complete this form and submit it to the Admissions Office along with your Enrollment Intent Form and $300 enrollment deposit as soon as possible. Submitting this form notifies us of your interest in living on-campus. The Office of Residence Life will contact you in early summer to complete a questionnaire for room and roommate assignment.

Required fields are noted in RED.

STUDENT INFORMATION

First Name	Middle Name	Last Name	Preferred First Name
Street Address	City	State	Zipcode
Gender: SU ID: Date of Birth:

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name

Work Phone

Home Phone

Cell Phone

Email Address

DISABILITY SERVICES/SPECIAL NEEDS

To request special housing accommodations for medical reasons please contact the Wellness Center at 443-352-4200. You will need to send the Wellness Center documentation from a medical professional stating the nature of your condtion to support your request.

What, if any, medications are you currently taking?

Do you have a disability requiring special attention in the residence halls? Yes No

If yes, please specify:

What accommodations have you made for any special needs you may have?

PLEASE READ AND DIGITALLY SIGN BELOW

The Office of Residence Life tries to situate students with roommmates with whom they will be compatible. SU cannot, however, guarantee this or assure that you will be placed in one of your top choices. Priority for assignment is based on a variety of factors, including but not limited to, date of enrollment deposit and your responses on the forthcoming housing questionnaire.

I understand that the University reserves the right to determine the final selection for housing. Further, I understand that this housing request is for the entire 2013-2014 academic year.

Student Signature	05/19/2013 Date
Parent/Guardian Signature (if student is younger than 18 years old)	05/19/2013 Date