Marshall University - Department of Residence Services

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Housing and Food Service Application

Directions:

Must be completed by the student applicant
Respond to all information requested

Student Information

Please select which category this application falls under:

First Time Freshman
Returning Student
Transfer Student

E-mail Address:

(Required, without a valid e-mail address, this web application will be denied)

Name:


Last	First	MI

MUID Number:

(ex. 901123456)

Mailing Address
Street:
City:
State:
Zip:

Home Phone:

ex. (123) 456-7890

Alternate Phone:

ex. (123) 456-7890

Fax:

ex. (123) 456-7890

Citizenship:

US
(Name of Country)

Gender:

Female
Male

Are you applying for housing for the first time?

Yes
No

Birth Date:

ex. 06/05/79

10.

Month and Year of High School Graduation:

(month/year, ex. 06/05)

11.

Class Standing:

APPLYING FOR HOUSING TO BEGIN:
12.	Year:
	Comments:

CHECK ONE MEAL PLAN OPTION (required)
13.	Unlimited Meals Per Week :	All Freshman are required to choose this option
	15 Meals Per Week:	Option for sophomores, juniors, seniors, and grad students
	10 Meals Per Week:	Option for juniors, seniors, and grad students
	If you have any dietary constraints, you can contact the TWIN TOWERS' SODEXHO FOOD SERVICE (304)696-2583

CHECK ONE RESIDENCE HALL OPTION

14.

All-female:

Buskirk (Limited number of Freshman students may reside in Buskirk)

Male and Female:

First Year Student Residence Halls (Opening August 2008)
Twin Towers East *** Either TTE or TTW will be available for summer session	Twin Towers West	Holderby
Haymaker (Marshall Commons)	Gibson (Marshall Commons)	Wellman (Marshall Commons)
***Willis (Marshall Commons) Contact Honors Office at (304) 696-5421

***Freshman students are required to live in the First Year Student Residence Halls with a limited number residing in Twin Towers East.
***Upper-class students may reside in all buildings other than First Year Student Residence Hall.

SECOND CHOICE:

ROOM OPTIONS (chose one)
15.	Room Type:	Double Occupancy (Required for Freshman students) Single Occupancy (where available)

SPECIAL INTEREST FLOOR CHOICE (choose one)
16.

ROOMMATE PREFERENCE (Request must be made by both parties, requesting the same options, and submitted together with deposits)
17.	Roommate Name:
	Roommate I.D.#:	(ex. 123456789)

DISABILITIES
18.	Do you have a disability which requires special accommodations? No Yes
	If yes, please describe:

EMERGENCY CONTACT
19.	Name:
	Relationship:	(ex. Mother, Brother, Friend)
	Phone Number:	(ex. (123) 456-7890 )

APPLICANT'S SIGNATURE
By signing this application, you agree that you are the student applicant listed, and that you have read and agree with the Contract for Student Housing and Food Service which becomes legally binding at the time of submitting this form.
20.	I understand that the Contract for Student Housing and Food is a legal and binding document and that I am agreeing to its terms. I will be liable for the remaining room and board fees if I leave housing before the contract ends. YES NO (Answering NO will result in your application being rejected) Freshman students should click “Yes” and will receive a Housing Contract via mail within a few weeks of applying.
	Signature (typed):
	Date:	(ex. 04/14/05)