HOUSING APPLICATION
Legal Name   Preferred Name
  First Middle Last     If Different
Street Address   Email
City, State, Zip   Country
Cell Phone ()     Home Phone ()   Church Affiliation
Father's Name
 
(Or Guardian)
 
 
Cell Phone
()
 
Home Phone
()
 
Email
 
Mother's Name
 
(Or Guardian)
 
 
Cell Phone
()
 
Home Phone
()
 
Email
 

Date of Birth
//
 
 
Sex:
Male
Female
Race (Optional):

African American
Asian American
Caucasian

Hispanic
Multiracial
Native American

Other

Anticipated Major:
 

Are you currently or have you previously attended any classes at Belhaven University?

Yes
No
What is/will be your classification at Belhaven University?

 
Fr
So
Jr
Sr

Transfer Students:  How Many
credits do you anticipate
transferring to Belhaven?
Is a Belhaven athletic team recruiting you?
Yes
No
      If “yes,” which one(s)?
For which term are you applying for housing?
Fall Semester
Spring Semester     20

MEDICAL INFORMATION
Information given above and below is intended for use in the event that the student named above becomes in need of medical attention.  Please be advised that Belhaven University and its employees are not responsible for monitoring the health of the student beyond the normal care given to each student and cannot be held liable for such care.

Allergies:
Medications Taken Regularly:
Physical or medical conditions that may need attention:

Physical or medical concerns requiring special housing considerations:
Emergency Contact(s):
Relationship to you:
Phone Number(s):
Medical Insurance (Company’s Name):
Policy and/or Group Number:

ROOMMATE SELECTION INFORMATION
The information you provide here will be used in assigning roommates.  Please answer honestly and thoroughly.  Even if you are requesting a specific roommate, this information is useful in the event that your chosen roommate falls through for some reason.  This information is confidential.

Hall Preference (if any):
Men:
Robertson
Women:
Caldwell
 
Wells
 
Gillespie
 
Helen White
Room Preference:
Standard Double
Designated Private (Gillespie and Helen White only)
Standard Double Room as Private (exceeds cost of standard double)
ATTENTION: Room & Board costs are the same for all Standard Double rooms and Designated Private rooms. Designated Standard Double Rooms as Private Rooms will only be available if occupancy allows. Read “Assignment of Rooms” in the Housing Reservation Agreement below for more details.

Roommate Preference(s):
(Each applicant must indicate their roommate preference in order to be assigned together.)
What qualities do you prefer in a roommate?
Christian
Same Major
Outgoing
Athletic
Studious
Involved
Quiet
Neat & Orderly

Roommate Communication Preference:
 
Cell Phone
Email
(Your selection above indicates that you agree to release your cell phone and/or email as listed to your roommate for communication.)

How important are the following activities to you?
1 – Not Important     5 – Very Important
 
1
2
3
4
5

Developing friendships
.................................................................

Participating in residence hall activities
.......................................

Participating in spiritual, ministry-type activities
.........................

Participating in athletics
...............................................................

Becoming involved in student leadership
.....................................

Becoming involved in campus activities, intramurals & clubs
.....

Academic achievement
.................................................................

For studying, do you prefer?
Quiet
Moderately quiet
Moderately noisy
Noisy
No preference
Sleep patterns:
Morning person
Somewhere in between
Night owl
How do you keep your room?
Messy
Somewhat unorganized
Somewhat organized
Neat & orderly


HOUSING RESERVATION AGREEMENT
HOUSING POLICY
Residence halls enhance the college experience by offering many outside the classroom educational opportunities to resident students. Close proximity to campus resources affords resident students the opportunity to become easily involved in campus activities. Resident students also tend to be more satisfied with their college experience, and are even more likely to graduate. For these reasons, all full-time freshmen and sophomores (under 54 credit hours), single and under the age of twenty-one, are required to live on campus, with the exception of those students who live off campus at the permanent address of their parents or legal guardian.

HOUSING RESERVATION
Belhaven University agrees to reserve a room and provide food service according to the terms stated below upon receipt of this signed agreement as well as verification of official acceptance to the University and payment of the enrollment deposit and payment of housing reservation deposit. Residents are required to comply with all rules and regulations of Belhaven University as stated in the student handbook. Should a resident fail to comply with said regulations, he/she may be removed from campus housing and forfeit the right to a refund of any charges.

CANCELLATION
In the event a prospective student/applicant decides not to live in the residence halls prior to moving into the halls, cancellation of the housing reservation deposit must be submitted in writing to the Office of Student Life, by July 15 for those applying for fall semester housing and by December 15 for those applying for spring semester housing in order to receive a refund of the housing reservation payment. Cancellation of the housing reservation after these dates will result in forfeiture of the $100 housing reservation deposit. Furthermore, the housing reservation deposit may be applied to any outstanding balance.

ASSIGNMENT OF ROOMS
Belhaven University attempts to make assignments of rooms and roommates in accordance with the requests of the applicants. However, since this is not always possible, Belhaven University reserves the right to make assignments to available spaces within the campus residence hall system. Belhaven University reserves the right to consolidate rooms each semester. Standard Double Rooms as Private Rooms are provided on the basis of availability and charges for these rooms will be assessed to the student’s account. Opportunities for room changes occur in accordance with established procedures at specific times during each semester.

RESERVATION
I request a room be reserved in my name for the
Fall
Spring 20
semester. Please use the information above when
making my room assignment.

 
Full Name:
Today's Date:
Agreed acts as your signature:
Yes
No

The Housing Reservation Agreement will not be processed until each of the steps listed below have been accomplished; priority for housing assignments is based upon completion of these steps:
 
You have been accepted to the University;
 
Payment of your $100 enrollment deposit;
 
Payment of your $100 housing reservation deposit.

The Office of Student Life cannot guarantee your choice of residence hall or roommate, but requests will be honored when possible. Requests will be processed based upon the availability of residence hall space. Your Housing Reservation Agreement is binding for the duration of your residency at Belhaven University except for periods when Belhaven University is not in session. It is the responsibility of the resident to become knowledgeable of and abide by Belhaven University policies.


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