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Residence Hall Application

Identification


Last Name:*

First Name:*

Middle Name:

Social Security Number:*

Street Address

City:*

County/Country:*

State:*

Zip:*

Telephone:*

Date of Birth:*
Gender:*

Email Address*
I am currently living in SAU's residence halls.  
   

Term Information

Academic Year:

 
   

Classification Next Term (Check all that apply)

  First Year
Sophomore
Junior
Senior
Graduate Student
Transfer Student

Preferences

Indicate any special health problems or disabilities that should be considered in making your room assignment. (If suitable space is available, your preference will be honored.  Special medical needs require written verification from a physician.
If you plan to participate in a varsity sport at SAU, name the sport:
 
Do you smoke?
Yes   No
Roommate Preference:
 
Would you prefer a roommate who smokes?
Yes   No
 

Residential Interest Groups

Please select your top 4 interest group choices.
Choice 1:*
Choice 2:
Choice 3:
Choice 4:
Other:

Meal Plan Options:

 

Please send a $50 check or money order made payable to Southern Arkansas University as a deposit for Residence Hall accommodations to P.O. Box 9431, Magnolia, Arkansas 71754-9431.

I understand that my $50 housing deposit will be refunded only if the contract for the term is cancelled by:
  August 1 for Academic Year    
  January 1 for Spring Only    
  May 1 for Summer session 1 only    
  June 1 for Summer session 2 only    
 
I make this application with the understanding that my Housing - Food Services contract will be for the entire academic year of two semesters (August - May) if I enter in the fall, and for one semester (January - May) if I enter in the spring semester. If the housing application is accepted, I agree to abide by all the rules and regulations of Southern Arkansas University and the Department of Housing.
  Date:  
 

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