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New Student Housing Card
For residence hall information and more: bethelu.edu/housing
What semester is this form for?
First Name
Your answer
Middle Initial
Your answer
Last Name
Your answer
Cell Phone Number
xxx-xxx-xxxx
Your answer
Email
Your answer
Address
Your answer
City
Your answer
State
Zip Code
Your answer
Birth Date
MM
/
DD
/
YYYY
Gender
Ethnic Origin
If Other, Please state...
Your answer
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