Housing Application

| More

The Office of Residence Life, Averett University,
420 West Main Street, Danville, VA 24541
434-791-5622

To be filled out by the student

(Please note: Housing assignments are based on date received. No housing assignment will be issued until the housing/enrollment deposit has been obtained and confirmed by the Business Office.. In addition, any roommate or residence hall request will be given preference based on the date of deposit.)

First Name		Middle Name	Last Name	Preferred Name


Street Address			City


State			Zip Code


Phone Number (home)			Age		Date of Birth


Cell Phone Number			Email Address

Male	Female

Freshman		Transfer	Readmit

Term and Year you plan to enter Averett University: Fall Spring Summer
Year:

Roommate Preference If you have a roommate preference, please give his/her name. Both roommates must request each other, submit the housing application, and deposit before the request can be honored. We will be unable to secure spaces for a preferred roommate without their housing application and deposit

Single Room Preference Singles are assigned based on availability. If you receive a single room assignment, you will be required to pay an additional fee of $800.00 per academic year to secure your private room. (No extra charge in Main Hall.)

Residence Hall Preference If you have a preference for a specific residence hall, please name the hall. Every effort will be made to honor your request, although it cannot be guaranteed. Please consider listing more than one hall preference.
1. 2.
3. 4.

Extra Long Bed Preference Extra Long beds are assigned based on availability. Please note above, if your need for an extra long bed is greater than your hall preference! Every effort will be made to accommodate both requests. (All beds in Danville Hall are Extra Long)

If you have special health or medical conditions that should be considered when making housing assignments, please indicate here and forward supporting medical documentation to the Office of Residence Life. Anticipated Major:

Which sport(s) might you want to participate in?

Housing Information
This information will help to find a roommate match and also plan programs for your hall.

Do you smoke?
Yes
No

Do you object to having a roommate who smokes?
Yes
No

Would you be interested in living with an international student?
Yes
No

Which statement reflects your expected college studying plans?
I plan to study several hours a day in my room.
I do not plan to study much in my room.

How do you feel about privacy in regards to your room?
Having people in my room at almost any time would be fine.
I would prefer as much privacy as possible.

How would you describe yourself?
I tend to be a morning person.
I tend to be an evening person.

How do you expect your residence hall room to look?
Everything will be in its place most of the time.
Things may be quite cluttered until I POST in a cleaning mood.

How would you best assess your values and beliefs?
Conservative
Liberal
Neutral

What statement best reflects you:
I tend to stay up late or into the early morning hours.
I prefer to be in bed before midnight most nights.

Do you participate in a social networking community (facebook, myspace, etc.)?
Yes (if yes, please indicate which site you use)
No

If so, are you interested in sharing this contact information with us and/or roommate(s):
Yes (if yes, please supply your contact info here:
No

Particular interests, hobbies, or sports you enjoy:

List three things that are important to you:

What activities were you involved in previously:

Other information that may assist us in assigning you a room
and a roommate:

Residence Hall roommates are assigned based on the
information supplied on this form and without regard to race, creed or national origin.

Once assigned a room and roommate the information will no longer be mailed to your home address. All information will be posted on your Averett student, self-service account. Directions to access this information are sent to you in your New Student Orientation Packet.

420 West Main St., Danville VA 24541

Phone: (434 ) 791-5600

1-800-AVERETT