HOUSING APPLICATION | Campus Living SIC

New Student Housing Agreement

Student's First Legal Name

Student's Last Legal Name

STUDENT'S EMAIL (this will be used for all communication & should not be parents email address)

STUDENTS PHONE NUMBER (this will be used for all communication & should not be parents phone number)

Additional Info - roommate request/private room request

Student's Birthday required

Please Note:

IMPORTANT INFORMATION:

Bank Routing Number (9 numbers)

Checking Account Number:

Please be sure to provide card number, expiration date, CVV and Zip Code below. Failure to provide all needed information will void this application and may have an impact on your room assignment.

Card Number

Expiration Date

CVV (3 numbers on back of card)

Cardholder's Zip Code

Disclaimer:

I have read the Disclaimer above and agree to such terms.

Thanks for submitting! Please note: your card payment will not be processed at the time of submission.

Processing of your payment may take up to 48 hours.

You will receive your receipt at the time our office runs your payment.