1. Status:
   

   Please check  your status for the 2013-2014 academic year

   Freshman

   Transfer

   
   
2. Name:
   

   Last Name

   First Name

   Middle Initial

   
   
3. Gender

   Gender

   Male

   Female

   
   
4. Permanent Address (this may not be an on-campus address):

   	City	State	Zip

   
   
5. Mount Student ID#:
   
   
6. Mount Email Address:
   
   
7. Cell Phone:
   
   
8. Home Phone:
   
   
9. Do you have any special needs which would require special housing?  Yes: No:
   (If you answer Yes, you must complete the Special Housing Accommodation Request Form available
   online at www.mountsaintvincent.edu/residencelife under the Housing Forms and Resources section.)
   
   
   
10. A meal plan is mandatory for all residential students. The college’s meal plan is based on a declining balance.
    
    
11. Do you smoke?  Yes No Note: Smoking is prohibited in all buildings, including residence halls
    
    
12. Can you live with a smoker?  Yes No
    
    
13. What time do you typically go to bed? 
    9PM-11PM
    11PM-1AM
    After 1AM
    
    
14. How do you like to study?
    With complete quiet. No radio /No talking.
    With light noise. Talking at a conversational volume, No Radio.
    With noise. Radio on is acceptable.
    
    
15. Are you participating in a Athletic Team?  If yes, which team?
    
    
16. Roommate Requests (First/Last Name)
    The person you are requesting as a roommate must also have your name on their application for the roommate request to be granted.
    

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Housing and Meal Agreement:

I hereby accept from the College of Mount Saint Vincent for the Fall 2013 through Spring 2014 a room assigned, or to be assigned, to me in the College’s residence hall subject to the Room and Board Contract & Policies as well as all regulations in the Student Handbook. The Contract & Policies agreement will be provided to me during the check-in process. All agreements are for the entire academic year, unless student meets criteria for housing cancellation. I understand that I must be registered as a full-time student (12 credits or more) to reside in College housing.

All housing applications should be received in the Office of Housing and Residence Life no later than June 14, 2013 for the Fall 2013 semester and January 6, 2014 for the Spring 2014 semester to be guaranteed on campus housing. All applications require a $200 damage deposit.