RUST RESIDENCE COLLEGE HOUSING …

rust RESIDENCE . COLLEGE HOUSING APPLICATION education . PERSONAL INFORMATION _____. MALE FEMALE rust COLLEGE #. _____. Last Name First Middle Street Address _____. City _____ State _____ Zip _____. Phone Number _____(Home) _____(Cell). Social Security # _____ Date of Birth _____. EMERGENCY CONTACT. _____ _____. Parent or Guardian's Name Relationship to Applicant Address _____ City_____ State ____ Zip_____. Telephone ( )_____. PREFERENCES. Requests will be honored, if possible RESIDENCE Hall: Emma Elzy Wiff Davage-Smith rust (First-time Freshman only) Gross (First-time Freshman only). Roommate: 1st _____ 2nd _____. 3rd _____ 4th _____. Do you have any physical disabilities or conditions warranting special consideration in making your room assignment? Yes No If yes, a statement from your physician must be attached. CLASSIFICATION: Freshman Sophomore Junior Senior Amount Enclosed $_____ Payment Confirmation #: _____. All residential students are required to pay a $ room reservation fee annually to reserve a space in campus HOUSING .

rust residence college housing application education personal information _____ male female rust college i.d.#

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