Housing Contract

Fields marked with an * are required

Personal Information

Email Address *

First Name *

Middle Name

Last Name *

Birthdate *

Cell Phone *

Mailing Address *

Country
Street
City
Region
Postal Code

Housing Information

Assignment Period *

Resident Status *

Room Type *

Meal Plan Selection *

19 meals per week is eating 3 meals a day.
14 meals per week is eating 2-3 meals a day.
10 meals per week is eating 2 meals a day.
75 meals per semester (Apartment / Commuter meal plan)

Are there special accommodations, health concerns, allergies, or limitations? Please explain

Residence Life will recognize and respect the gender identity that students self-identify. Students may contact the Residence Life office if they wish to receive special housing considerations regarding their gender identity.

Gender *

Roommate Preference Questionnaire

Smoking *

Cleanliness *

Room Environment *

What are your favorite interests and activities?

What type of music do you listen to?

Personal Hours *

I plan to go home *

Socializing in the halls *

Roommate relationship *

If you have a preference of a roommate, please list here Both persons must request each other.

Is there anything else you would like us to know as we determine room assignments and roommate pairings?

Signature

Room rental and board plan prices may be viewed online HERE.

Residence Hall Contract Terms and Conditions

Terms and Conditions *

I verify I have read and understand the above terms and conditions and I am agreeing to them. *

This form, when submitted with appropriate electronic signature(s), is a request to rent Clarke University residence hall space.

Resident Signature *

Date*

Parent or Guardian Signature (If resident is under 18 years of age)

Date