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ResLife Application
First Name:
Middle Name:
Last Name:
Preferred Name:
UMobile ID Number (get this form from your enrollment counselor):
Gender:
Choose a Gender
Male
Female
Date of Birth:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
Year
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
Applying for Entry Year:
Choose a Semester
Summer 2012
Fall 2012
Spring 2013
Summer 2013
Fall 2013
Spring 2014
Summer 2014
Fall 2014
Entering as a:
Choose Type
Freshman
Transfer
Email Address:
Cell Phone:
Will you have a vehicle on campus?:
Choose one
Yes
No
Maybe
Name(s) of Parent/Guardian:
Roommate Preference:
I would like to request a specific roommate. *Note: This person must also request you on their application.
I do not have a specific preference.
I request a private room. *Note: Private rooms are based on availability and cost an additional $500 per semester.
Name of Desired Roommate (if requesting a specific roommate):
I desire a roommate with the following qualities (check all that apply):
Night Owl
Early Bird
Neat
Somewhat Messy
Serious
Organized
Talkative
Fun-loving
Quiet
Private
Playful
Studious
People Person
Procrastinator
Comments/questions:
List any special needs you have:
I would describe myself as (check all that apply):
Night Owl
Early Bird
Neat
Somewhat Messy
Serious
Organized
Talkative
Fun-loving
Quiet
Private
Playful
Studious
People Person
Procrastinator
Residence Hall Preference (*Placement will be made based on
the gender assigned to each individual residential facility):
Choose a location
Samford or Faulkner Hall (private style)
Ingram Hall (suite style)
Arendall Hall (suite style)
Bedsole Hall (suite style)
Select the Meal Plan you desire:
Choose a Plan
19 Meal Plan
15 Meal Plan
10 Meal Plan
Allergies:
Medications taken on a regular basis:
List any pre-existing health concerns/issues:
Insurance Information:
Primary Company:
Address:
Phone Number:
Primary Cardholder:
Group Number:
Policy Number:
Effective Date:
Down Payment Information (Residential placements will
not be made until housing down payment is received):
Have you paid your $500 down payment?:
Yes
No
Captcha Image (Security Code):