Housing Application

Semester to Begin Residence

Personal Info

Username

First Name

Last Name

E-mail Address

Password

Confirm Password

Upload a Picture of You

Birth Date

Your Phone Number

Home Address

City

State

Zip Code

Education

Current Grade Level

Proposed Degree

Your Parents Info

Your Parents' Names

Parents Phone Number

Parent's Email

Home Church

Name of your home church

Name of the staff member who knows you best

Phone Number

Church Staff Email

Church Address

City

State

Zip Code

Additional Reference

Name

Relation to you (e.g. teacher, coach, employer)

Phone Number

Reference Email

Education

Briefly state how you found out about the Campus House and why you are seeking housing with us.

List any leadership roles in which you have served.

What talents and interests do you have that you desire to explore while you are a resident?

Have you ever been convicted of a crime? If yes, please explain.

List any medical conditions or allergies. (Optional)

List any medications you take on a regular basis. (Optional)

What is your favorite bible verse?

Help Us Connect with You

Twitter Username

Facebook Username

Instagram Username

Only fill in if you are not human

Housing Application

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