Housing Application Semester to Begin ResidenceSpring 2022 Applicant - WomenSpring 2022 Applicant - MenSummer 2022 Applicant - WomenSummer 2022 Applicant - MenFall 2022 Applicant - WomenFall 2022 Applicant - MenPersonal InfoUsername First Name Last Name E-mail Address Password Confirm PasswordUpload a Picture of You Upload PhotoUpload a Picture of YouBirth Date Your Phone Number Home Address City State Zip Code EducationCurrent Grade LevelHigh School JuniorHigh School SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorGraduate StudentProposed Degree Your Parents InfoYour Parents' Names Parents Phone Number Parent's Email Home ChurchName 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 ReferenceName Relation to you (e.g. teacher, coach, employer) Phone Number Reference Email EducationBriefly 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 YouTwitter Username Facebook Username Instagram Username Only fill in if you are not human