This form must be fully completed and returned to the office of Student Housing by the date specified. 
Payment of reservation fee must be paid receipt attached in order for this application to be considered. 
TO: 
ALL CAMPUS STUDENTS 
FROM: 
DATE: 
STUDENT HOUSING SUPERVISOR 
Campus residents requesting residence hall accommodation for the Fall/Spring semester must 
submitt a room reservation form with a recipt of the $100.00 deposit. 
Room Reservations received after the deadline date will be handled on a space available basis. 
Please note; Students are limited to eight (8) semesters in the Residence Halls.  The office of 
Student Housing reserves the right to make residence hall or room changes for the benefit of all 
RESIDENT NAME: ____________________________________________________ (Please Print) 
 Last                                  Middle                                 First 
DATE: ____ / ____ / ____ 
 STUDENT NO: ____  ____  ____-____  ____-____  ____  ____  ____ 
CAMPUS ADDRESS: ________________________    ____________________    _______________ 
 Residence Hall 
 
         Suite 
 
      Room 
CAMPUS MAIL BOX: ______  TEL:  ____ ____ ____  -  ____  ____  ____  -  ____  ____  ____  ____ 
REQUEST A ROOM CHANGE: 
 YES 
 NO
ROOM CHANGE:   _________________________    ____________________    _______________ 
 Residence Hall 
 
         Suite 
 
      Room 
ROOMMATE REQUEST: ______________________ 
MEAL PLAN:    ( A )
( B )
ROOM RESERVATION 
REVISED SPRING 2007 
Office Use Only 
RECEIPT NO: ___________________________ 
DATE RECEIVED:  ____ / ____ / ____ 
Room Assignment: ______________________ 
__________________________________________ 
 Student Housing Representative 
_____________________________________________ 
Resident Signature