Horizons Housing Application
Beginning Fall, 2008 and ending Spring, 2009
Last Name
First Name and Middle Initial
Student Number
Permanent Address
Street, City, State or Province, Zip Code, Country, Name of Parent/Guardian
Sex
Male
Female
Age
Date of Birth
Month/Day/Year
Religious Affiliation
(optional)
Country of Origin
E-mail Address
Local Phone
(required)
Proposed Major and Year
Do you smoke?
(All rooms are non-smoking)
Yes
No
We do not allow smoking. Will you abide by this?
Yes
No
I often stay up past midnight.
Yes
No
I often rise by 7:00am.
Yes
No
Are you particularly messy?
Yes
No
Are you particularly neat?
Yes
No
Are you particularly studious?
Yes
No
Do you prefer a quiet environment?
Yes
No
Do you have a car you want to park at HISC?
Yes
No
Do you have a bike you want to store at HISC?
Yes
No
Is this your first time living in the United States?
Yes
No
When do you want to live at Horizons?
(Move In) mm/dd/yy to (Move Out) mm/dd/yy
Please list your special interests/hobbies:
What type of room do you prefer?
(check one type of room and one type of bath)
Single Room
Double Room
Triple Room
Shared Bath
Semi-Private Bath
There are limited singles, are you willing to share if no singles are available?
Yes
No
Roommate Request
Special Dietary Needs/Requests/Allergies
I, the person named above, hereby affirm that I have answered the questions in this application truthfully and honorably, and in doing so, I have requested the opportunity to live at Horizons. I understand that there is a higher demand for occupancy than there is space available and that my application will be given equal consideration.
Name and Date