[[[["field20","equal_to","Yes"]],[["show_fields","field70"]],"and"]]
1 Step 1
ABU Official Housing Request
THIS FORM MUST BE COMPLETED BY THE INCOMING STUDENT

::::::: PERSONAL INFORMATION

Student ID #
Gender
Date of birth
First Name
Middle Name
Last Name
Home phone
Mobile phone
Home Address
City
State
Zip/Postal Code

::::::: ACADEMIC INFORMATION

Will you be a student athlete at AB?
Which sport?

::::::: HOUSING PREFERENCES

Indicate which semester(s) housing will first be needed.
Please take some time to review the different residence halls available at Alderson Broaddus University.

If you require Housing Accommodations due to medical or other documented need, please submit a completed Housing Accommodation Request Form.
Hall preference - please rank 1-7 (1 being top preference)

::::::: ROOMMATE PREFERENCES

Requested Roommate or preference.(ex. Name, a teammate,etc.)
Remember, roommate requests must be mutual. If a roommate is not requested, one will be assigned.
Are you a smoker
Do you object to living with a smoker?
Do you tend to:
Which best describes you?
Which best describes you?

::::::: BACKGROUND STATEMENTS

If you answer to either question below is ‘Yes’, please submit a letter of explanation to studentaffairs@ab.edu. Please note that an affirmative response will NOT result in an automatic rejection of your request for university housing. If necessary, Alderson Broaddus University may request that you sign a release so that proper inquiries may be made regarding the circumstances related to your responses below.
Have you ever been convicted of a criminal offense or found guilty by a juvenile court?
Have you ever been suspended, dismissed, or separated from any secondary school, college or univeristy you have attended?

::::::: EMERGENCY CONTACT #1 INORMATION

Contact #1 Name
Contact #1 Relationship to you: (parent, sibling, spouse, etc.)
Contact #1 Daytime Phone
Contact #1 Evening Phone
Contact #1Other Phone
Contact #1 Address
Contact #1 City
Contact #1 State
Contact Zip/Postal Code
Contact #2 Name
Contact #2 Relationship to you (parent, sibling, spouse, etc.)
Contact #2 Daytime Phone
Contact #2 Evening Phone
Contact #2 Other Phone
Contact #2 Address
Contact #2 City
Contact #2 State
Contact #2 Zip/Postal Code
Digital Signature
Previous
Next