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This
application must be completed by all students who desire
to live on Campus.
Please return the completed application , with the required
$150.00 non-refundable Housing Application Fee to the
Office of College Housing, Miles College, P. O. Box 3800,
Birmingham, Alabama 35208.
A room cannot be assigned until the Housing Fee has been
received.
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I
NEED HOUSING FOR:
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) Fall (August) 200__ |
(
) Spring (January) 200___ |
(
) Summer 200___ |
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| NAME: |
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SOCIAL
SECURITY #: |
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Last |
First |
MI |
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| HOME
ADDRESS: |
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Street |
Apt/Bldg
# |
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City |
State |
Zip
Code |
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| PHONE:
( ) |
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BIRTH
DATE: |
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SEX:
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(
) Male |
(
) Female |
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Month |
Day |
Year |
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| STUDENT
CLASSIFICATION: |
(
) Freshman |
(
) Sophomore |
(
) Junior |
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(
) Senior |
(
) Transfer |
(
) Transient |
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| NAME
OF PARENT OR GUARDIAN (Who to notify in case of emergency): |
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| NAME: |
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RELATIONSHIP: |
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| ADDRESS: |
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PHONE:
( ) |
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Street |
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Apt
# |
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City |
State |
Zip
Code |
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| If
you wish to specify a roommate, you must make sure that
both requests and fees are submitted in a timely manner. |
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| ROOMMATE
REQUEST: |
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| NAME: |
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| SOCIAL
SECURITY #: |
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