Housing Application

Housing Semester Applied For

Personal Information

First Name Last Name Address City State Zip Code/Postal Code Country (if not USA) Email Address Home Phone (Include area code) Cell Phone (Include area code) Gender Birthdate (mm/dd/yyyy) Age

Permanent Home Address

Address City State Zip Code/Postal Code Country (if not USA) Phone

Emergency Information

In case of an emergency, the University may contact the following person: Name Address City State Zip Code Phone

Student Classification (check one)

Freshman Sophomore Junior Senior Graduate

Housing Application Status

New Student Transfer Returning UD Student

University of Dubuque residence halls are according to the Student Handbook smoke free and alcohol free environments.

Do you smoke?
     Yes    No Do you object to a roommate who smokes?
     Yes    No Are there any health concerns, limitations, allergies, special accommodations or continuing medication needs you feel should be taken into account when assigning you a room?
     Yes    No
    If Yes, please specify
     The University of Dubuque has a large multi-cultural program and encourages students to consider living with a student from another country. To take advantage of this unique opportunity, please check the appropriate box.
       Yes, I am interested in living with an international student.
       No, not at this time.
       No Preference

Please list your academic major or interests: Please list any extracurricular activities in which you participate: Please list the varsity sports in which you plan to participate: Please list some of your hobbies: What style of music do you prefer? What is your religious preference? If you would like to request a roommate, please do so here:
(We cannot guarantee that your request will be granted, but we will try to honor your request.)

Please respond to the following statements by checking the box to the right of each statement that is most characteristic of you. Remember that your responses to these questions will help us in selecting your roommate.

	Never	Rarely	Sometimes	Frequently	Always
I get up early (before 8:00 a.m.).

I go to bed late (after 11:00 p.m.).

I keep my room neat and clean.

I am comfortable with other people using my belongings.

I like to study in absolute silence.

I like to play my stereo loud.

I am comfortable in large groups of people.

I plan to participate in church-related activities.

I like to exercise on a regular basis.

I want my roommate to be one of my best friends.

I like to have people over to my room.

I am comfortable expressing my feelings.

I plan to go home on weekends.

I follow a schedule regularly.

RESIDENCY POLICY

The University of Dubuque residency policy stipulates that all students having earned less than 90 class credits must reside in campus housing units, space permitting, unless they meet one of the following criteria:
1. Married and living with spouse
2. Have and living with a child(ren) or legal dependent(s)
3. Living with and commuting daily from the home of an immediate relative (parent, grandparent, sibling, legal guardian) within 50 miles of Dubuque

IMPORTANT

After having read this, I understand the above guidelines as stated and realize that upon check-in to the hall I will be required to sign a one academic year housing agreement.

We cannot process your application without your verification below.

I have verified the information

Date: