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Singles-Undergraduate Housing Application
Leavell College Housing Application
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Name *
Are you an online student? *
Are you currently a student commuter? *
Today's Date *
MM
/
DD
/
YYYY
Requested Move In Date, if different from Campus Dorm Move In   *
MM
/
DD
/
YYYY
Student I.D. Number *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address (street, city, state, zip code) *
NOBTS Student Email *
Cell Phone Number *
Cell Phone Provider *
Would you like to receive texts from the Housing Office? *
Student Status *
Would you like a semi-private dorm or a private dorm? *
Dormitory: requested roommate's name
Do you have any medical reason to not be assigned to a Dorm? Please explain:
Is there anything else you would like us to know?
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