1. Status:
   

   Please check  your status for the 2012/2013 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, then you must complete the Request for a Medical Single or
   Special Housing Accommodation available online at www.mountsaintvincent.edu/residencelife.)
   
   
   
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? (select one) 
    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 2012 through Spring 2013 a room assigned, or to be assigned, to me in  the College’s  residence hall subject to the Terms and Conditions of the Room and Board agreement outlined in the Student Handbook.  This agreement will be provided to me during the check-in process in August. 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 Residence Life and Housing no later than June 1, 2012 for the fall 2012 semester and January 7, 2013 for the spring 2013 semester to be guaranteed on campus housing.  All applications require a $200 damage deposit.