Housing Application

First Name

Last Name

Middle Name

Address

City

State/Province

Zip/PC

Email Address

Home Church

Home Phone

Cell Phone

Gender Male Female

Date of Birth

Current Age

Name of parent(s) or guardian(s)

Last High School Attended

Year of 12th Grade Graduation

Enrollment Date

Student Type

Admissions Counselor

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Do you plan to live at home and commute to Dordt University? Yes No

SELF DESCRIPTION

Please select the words from each pairing below that best describe you.

I am more likely to be: Neat Messy

I am more likely to be: Expressive Reserved

I am more likely to be: Adventuresome Cautious

I am more likely to be: Impulsive Deliberate

I am more likely to be: Casual Formal

List any five words to describe your personality:

List any five words to describe the person with whom you will like to live:

My musical tastes are:

My hobbies are:

Activities I would like to be involved in (extra-curricular):

My vocational goal (major) is:

Do you smoke? Yes No

(In compliance with state law, Dordt University is a smoke free campus.)

Sleep habits:

Specific roommate request (must be made by both people in order to be honored):

I have a medical specialists order for special housing or dietary accommodations: Yes No

(*Note: This does not guarantee an accommodation will be made. A Dordt representative will review your request and contact you for further information.)

If yes, explain:

Please select a meal plan: Value Meal Plan (Underclassmen) Reduced Meal Plan (Underclassmen) 5 Meal Plan (Upperclassmen) Value Meal Plan (Upperclassmen) Reduced Meal Plan (Upperclassmen)

*Note: Click here for meal plan information.

Do you intend to have a vehicle on campus? Yes No

Upload a picture of yourself:

Drag and drop files here or click to upload

I accept the responsibility of becoming a member of the Dordt University residential community. I understand this responsibility involves upholding specific standards of behavior, as outlined in the Living in Christian Community brochure and other college publications, that enhance the welfare and best interest of the entire Dordt community. I agree to live according to those standards. I understand that if my living unit is not at full occupancy, a new resident may be assigned at any time. I agree to accept a new roommate in that situation. Yes No

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Housing Application

SELF DESCRIPTION