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Your Name*
FirstLast
Permanent Address*
Street AddressCityStateZip Code
Home Phone*
Cell Phone*
Email*
Date of Birth*
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Parent / Guardian
Name*
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Phone*
More About You
Gender*
- Male
- Female
Year*
- Freshman
- Sophomore
- Junior
- Senior
Major
Have you ever been convicted of an/or pled “guilty” or “no contest” to any felony regardless of whether such action resulted in jail or prison time served and/or deferred adjudication?*
- Yes
- No
Have you ever been convicted of an/or pled “guilty” or “no contest” to an misdemeanor involving theft, burglary, physical assault, indecent exposure, sexual molestation, regardless of whether such action resulted in jail or prison time served and/or deferred adjudication?*
- Yes
- No
Are you currently on probation, parole or suspended sentence for any conviction?*
- Yes
- No
Roommates
Is roommate matching needed?*
- Yes
- No
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Parent / Guardian