WilliamPennUniversity

Housing and Meal Plan Application

*$100 Housing Deposit Required*

This application is for the following session (check only one):Academic Year______Fall _____ Spring_____

I. Personal Information

Name______Gender M F

Last First Middle Social Security Number

Home Address______

Street City State Zip Code

Home Phone Number (_____)______Date of Birth ____/____/____ Class Entering ___Fr ___So ___Jr ___Sr

II. Request for Residence Hall

Rank order your top 2 choices (#1 = top choice) ___Watson Hall (men only) ___Lewis Hall (women only) ___Eltse Hall (co-ed)

___ TwinTowers (upperclassmen)

Room occupancy preference (#1 = top choice) ___ Double (w/roommate) ___ Conditional Private- no roommate and an additional $300 per semester

Private rooms are granted on a seniority basis)

III. Request for Roommate

Please specify if there is someone who will be or is attending WPU with whom you would like to share a room:

______

Last nameFirst name

____Yes ____NoPreferred roommate is more important than hall preference?

____Yes ____NoI lived at William Penn previously in ______Hall.

____Yes ____No*Do you smoke?

____Yes ____No*Do you object to having a roommate who smokes?

*As of July 1, 2008, Iowa law prohibits smoking in all buildings, throughout campus grounds and in vehicles on campus.

____Yes ____NoI like to stay up past midnight.

____Yes ____NoI usually rise before 8:00 am.

____Yes ____NoDo you play a sport? If so, which one? ______

____Yes ____NoI am very tidy.

____Yes ____NoI would prefer a quiet life style.

What are some of your hobbies and interests? ______

What type of music do you listen to? ______

___Yes ___No I have a special physical need and/or health condition that should be considered in making these assignments. (Please attach a written

explanation and physician information about this.)

Other information we should know about you: ______

I hereby apply for the academic year or the balance thereof. I have read and will abide by the terms and conditions of the room and board contract. Requests for refund of housing deposit must be postmarked by May 1 for the fall semester and December 1 for the spring semester. I understand that if I am ever released from the residence halls due to a Judicial Board hearing, I will lose my deposit as well as my room fees.

Signature______Date______

NOTE: Every attempt will be made to honor your requests. However, specific room and roommate requests cannot be guaranteed. William

PennUniversity does not discriminate on the basis of race, religion, gender, age, sexual orientation, veteran status or disability.