Office Use Only: Application: _______________ Room Deposit: _______________ (Residence Life Office) (Campbell Solution Center) Office of Residence Life Housing Application for Current Students 2015-2016 Academic Year All housing applications must be completed by the applicant and submitted directly to the Office of Residence Life. All room deposits must be submitted directly to the Campbell Solution Center. Students with outstanding balances or holds with the University may not proceed in selecting a room until all holds have been resolved. Specific housing assignments are made based upon the date the Campbell Solution Center receives the $250 room deposit and the Office of Residence Life receives the Housing Application. The deadline for both the housing application and room deposit is Friday, February 27, 2015 or December 4, 2015 (for Spring 2016). Please note that the University cannot guarantee oncampus housing. Contact Information (required) Name: ______________________________________________________ Female Male Permanent Address: _______________________________________________________________ Street _______________________________________________________________ City State Zip code Primary Phone Number: (______)___________-___________ General Information (required) Fall 2015 Standing: Sophomore Junior Current Standing: Resident Commuter I request housing for: Fall 2015 & Spring 2016 Senior Fall 2015 Only Graduate Student Spring 2016 Only Major: _____________________________________________________________________________ Meal Plan (required) All Residents are required to be on a meal plan in order to reside in the residence halls. Please select:  19 Meal Plan: 19 meals/wk + 100 M.E.R.V. Bucks/semester  15 Meal Plan: 15 meals/wk + 200 M.E.R.V. Bucks/semester  10 Meal Plan: 10 meals/wk + 250 M.E.R.V. Bucks/semester Housing Preferences (required). My building preferences are [rank 1 (highest) – 3 (lowest)]: ____ St. Brigid Hall Suite doubles ____ Siena Hall Suite doubles ____ Alexandria Hall Traditional doubles, suite doubles & deluxe suites Roommate Lifestyle Preferences (required) I prefer studying with:  Quiet  Noise I am a:  Night person  Morning person Rate yourself:  Neat  Messy I am a:  Smoker  Non-Smoker  No Preference (Please note that University Policy prohibits smoking in the residence halls.) Current students will have the opportunity to select their housing preference and roommates during the Room Selection Process; however the information above is important for application purposes. Special Housing Options (optional) Quiet Lifestyle Floor Please check here if you are interested in residing on the Quiet Lifestyle Floor. Please note you must sign and return the Quiet Lifestyle Agreement with this Housing Application in order to be considered for this option. Please note that availability on a Quiet Lifestyle Floor is not a guaranteed living option and is a first-come; firstserve basis. E-STEM Living Learning Community Please check here if you are interested in residing on the E-STEM Living Learning Community. This area is designated primarily for students who are biology, computer information science, and mathematics majors at the University. This particular living-learning community will benefit your goals of achieving academic success through STEM-specific programming, as well as monthly academic and social activities. An E-STEM Housing Agreement must be completed by the applicants and approved by an E-STEM administrator. Disability Housing Accommodations If you require housing accommodations due to a physical impairment or a medical condition, you must submit a Housing Accommodation Request Form and the Release of Information Authorization form to the Disability Support Services Coordinator. This form must be completed by your physician and received by the Disability Support Services Coordinator by February 27, 2015. Forms not submitted by the deadline or not completed thoroughly, may not be considered or approved for special accommodations. Forms and additional information can be found by visiting the Disability Support web page. If you need further assistance or have any questions, please contact the Disability Support Services Coordinator at [email protected] or 215-646-7300 x427. By signing below, I understand that the university cannot guarantee on-campus housing and I agree that I have completed this application truthfully and understand that any false information may result in my being denied entrance to, or immediately dismissed from, the Residence Life program at Gwynedd Mercy University. Furthermore, I understand that my signature below indicates that I have read and understand the Gwynedd Mercy University Residence Hall Contract, Room Selection Guidelines and Procedures and hereby agree to abide by all the policies therein contained. Signature: _______________________________________________ Date: _____ / _____ / _____ Signature: _______________________________________________ Parent/Guardian [if applicant is under 18 years of age] Date: _____ / _____ / _____ Please return the Housing Application to the Office of Residence Life