University Of Memphis Residence Life and Dining Services

Department of Residence Life and Dining Services
Housing Application Please complete all sections of this application. All applicants for housing are responsible for reading and knowing the Residence Life Policies and Procedures Information.

Last Name: First Name: Middle: Social Security Number:

Permanent Address:
                            City:      State:    Country:    Zip Code:
           Area Code: Phone:
                  Email:

Age: Birth date: Gender:

      Current Address:
                            City:      State:    Country:    Zip Code:
                Area Code: Phone:
                          Email:

Classification: Do You Smoke? Will You Accept A Smoking Roommate?
Have You Ever Applied For Resident Accommodations at The University of Memphis? If Yes, What Year?

ACCOMMODATION PREFERENCES
I Will Need Housing Beginning:
Room Type:

Please list the appropriate halls in order of your preference (with the first being the most important).   Please do not rank any hall to which you do not wish to be assigned. Law Students requesting housing are required to live in the Carpenter Complex Apartment and Townhouses.
    First Preference for Building: #1
Second Preference for Building: #2
   Third Preference for Building: #3
Fourth Preference for Building: #4
    Fifth Preference for Building: #5

Summer Session Options: The Carpenter Complex

Do you have any physical disabilities or conditions warranting special consideration in making your room assignment? If you answered yes, please provide a brief description:

To be considered you must attached a statement from your physician or
the Director of the Office for Students With Disabilities.

ROOMMATE PREFERENCES
Please list your roommate preferences. Please use their full name and social security number.
Last Name: First Name: Middle: Social Security Number:
Last Name: First Name: Middle: Social Security Number:
Last Name: First Name: Middle: Social Security Number:
Last Name: First Name: Middle: Social Security Number:

STUDY QUIET AREAS
If you wish to be considered for assignment for a Study Quiet area, please indicate and sign this section of the application.
Choose a preference:

I, ,have read the information pertaining to the Study Quiet area in the The Policies and Procedures section of this web site. If I am assigned to a Study Quiet area, I agree to abide by these conditions.

Signed ___________________________________________________ Date _____________________
Student (Sign only if you want a Study Quiet area)

HOUSING TERMS AND CONDITIONS
UPON SIGNING THIS APPLICATION, I HEREBY AGREE TO THE FOLLOWING TERMS AND CONDITIONS:
I understand that the University shall have no responsibility for the theft, destruction, or loss of moneys, valuables, or other personal properties belonging to or being in my custody from any cause whatsoever, whether such losses occur from my room, apartment unit, a storage room, or a public area. I have read, and agree to, the policy regarding cancellation deadlines for specific terms contained in the material located in the The Policies and Procedures section of this web site. The Associate Dean of Students for Residence Life and Dining Services reserves the right to refuse any application, to cancel or change any assignment, to consolidate residents when necessary, or to terminate a resident's occupancy for breach of contract ( i.e. violation of visitation, vandalism, possession of and/or use of illegal drugs, tampering with fire equipment, etc.) Upon signing this application, I hereby agree to comply with all rules and regulations contained in the current University of Memphis Student Handbook and the Residence Life Information Brochure or as both may be amended and which I hereby acknowledge receipt there of; and further agree to the additional terms and conditions of the Study Quiet Agreement for the duration of my residence. Parent's signature proves knowledge and supports intent of this agreement and guarantees payment of applicable charges.

Signed _________________________________________________________ Date __________________________
Student

Signed _________________________________________________________ Date __________________________
Parent or Guardian (if student is under legal age)

APPLICATIONS FOR HOUSING MUST BE SUBMITTED TO:

RESIDENCE LIFE AND DINING SERVICES
THE UNIVERSITY OF MEMPHIS
011 RICHARDSON TOWERS
MEMPHIS, TN 38152