Tri-State University - International Student Housing

PERSONAL Information
Name on Passport
Prefered Name
Passport Number (optional)
Gender	Female Male
Date of Birth
Street
City
Providence
Country
Home Phone
Mobile Phone
E-Mail
Academic, Housing and Meal Plan Information
Anticipated Major
Housing beginning	Year:
Academic Status
Incoming Status
Meal Plan Choice
Emergency and Medical Information
Emergency Contact
Emergency Phone
Any medical or physical conditions that need to be considered when assigning housing.
If yes, please explain
Personality and Roommate Preferences
I believe that roommates should:
The relationship I would like with my roommate is to:
I prefer our room to be:
When I study, I prefer:
I prefer to live in a:
The University is smoke-free; but I prefer to live with a:
On average, I get up:
On average, I go to bed:
Please choose your residence preference within the appropiate pull down menu.
By submitting this form, in the event of serious illness or accident, I give Tri-State University or its representative(s) permission to secure medical and/or surgical care to include transportation to a doctor or hospital of their choice, injections, examination, medication and surgery that is considered for my good health. I agree to pay all medical costs. The housing request will not be processed until your $150 Housing Damage Deposit (which is a portion of your $300 Enorollment Deposit), your Housing Contract and this Housing Information Form are received by the Director of Residence Life. For new TSU students, housing assignments will be made on June 1 and July 1. Housing requests submitted after July 1 will be assigned as received. Your building and roommate requests are not guaranteed, but requests will be honored when possible. By submitting this form, I verify that I personally completed the Housing Information Form and acknowledge that this information will be used in matching me with a roommate.