Housing Form

Personal Information

First name:

Middle initial:

Last name:

Preferred name:

Street address:

City:

State/Province:

Zip/Postal code:

Home Phone number – Including area code:

Cell Phone number – Including area code:

Birthdate (Month/Day/Year):

Gender:

Male
Female

Parents Information

Mother's name:

Father's name:

Meal Plan Selection

Meals per week:

Red - 19 meals per week. 3 meals per day Monday-Friday and 2 per day Saturday and Sunday.

Silver - 14 meals per week. 2 meals per day Monday-Friday and 2 per day Saturday and Sunday

White - 14 meals a week. 3 meals per day Monday-Thursday and 1 on Friday

Enrollment Information

I am a

Entering semester:

Residence Hall Preferences

All first year students will be placed in residence halls. Assignment preferences are honored in order of housing application date received. Specific room accommodations may be requested at the end of this housing form but are not guaranteed.

Dorm Choice Rankings

In order to continue, please answer "Gender" and "I am a" questions above.

Physical or health conditions

Please specify if you have any physical or health condition(s) which require special attention:

I require air conditioning:

Yes
No

Students who request a room with air conditioning will be assigned to Scholte or Graham Halls. Documentation from a physician will be required to show need.

Roommate Matching Data

Roommate Preference?

Yes
No

Roommate preference must be mutual and will only be honored if both applicants have paid deposits prior to May 30.

Preferred Roommate Name:

Preferred Roommate Hometown:

Do you smoke?

Yes
No

Do you object to a roommate who smokes?

Yes
No

Central is a smoke free campus.

Are you interested in having an international (non-United States) student as a roommate?

Yes
No

I feel most comfortable when my room is:

I consider myself to be a:

Hours of sleep I generally need each night:

When I study I:

I plan to do most of my studying:

The types of music I listen to most often are (check 3)

I plan to major in:

Please list the co-curricular involvements, hobbies, and interests you have:

Would you like to live with someone with the same co-curricular involvement as you?

Yes
No

Which activity is most important?

Please share what you're looking for in a roommate, what you think is most important to you when matching with a roommate, and any additional information you feel we should consider as we work to assign you a roommate:

If you have a question about this form, please contact Chevy Freiburger, Director of Admission, at 877-462-3687 or email freiburgerc@central.edu.

Campus Life

Personal Information

Parents Information

Meal Plan Selection

Enrollment Information

Residence Hall Preferences

Dorm Choice Rankings

Physical or health conditions

Roommate Matching Data

The types of music I listen to most often are (check 3)

I'm looking for:

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