** Please Note ** Deposit must be paid before housing information is processed. As a full-time student at University of the Cumberlands, you must reside in the college housing unless you meet one or more of the criteria for a housing excuse.

Only those persons who are approved for a housing excuse may reside off-campus.


STUDENT STATUS
DESIRED DATE OF ENROLLMENT
ID Number: What's my ID?

Personal Information

Last NameFirst NameMiddle NamePreferred Name


Home Address Country: USA Other

Home Address
CityCountyStateZipCountry
Home PhoneCell PhoneSexHeightWeight
Month Day Year
Marital Status
Date of Birth

Family Data

Father's Last NameFirst NameMiddle NameOccupation


Home Address Country: USA Other

Home Address
CityCountyStateZipCountry
Home PhoneOffice PhoneCell Phone
Mother's Last NameFirst NameMiddle NameOccupation


Home Address Country: USA Other

Home Address
CityCountyStateZipCountry
Home PhoneOffice PhoneCell Phone
Marital Status

Emergency Contact

Household Contact
Last NameFirst NamePhone Number
Non-Household Contact
Last NameFirst NamePhone Number

Room Preferences

Your repsonse to the items listed will help us in making your roommate assignment.


Please list the name(s) of specific roommate requests. (All roommates must request one another and requests must be received no later than June 1 in order to be considered. Leaving blank signifies you have no preference.)

  1. First Name: Last Name:
  2. First Name: Last Name:

Please indicate any factors that you believe need to be considered in making your roommate assignment, including health issues:

What time do you usually go to bed?

What time do you usually rise in the morning?

How important is a neat room?

Do you smoke? - (All campus buildings are tobacco-free)


Study Habits







Religion

  1. Denomination/Religious Affiliation:


Personal Traits




Music

  1. I enjoy:



  2. I listen to music:
  3. Do you listen to music when you study?
  4. When listening to music do you wear headphones?
  5. Do you listen to music or TV while you sleep?
  6. Are you a member of the band?

Extracurricular

  1. I have been recruited for the following sport:
  2. I would like to participate in the following clubs/organizations:














Residence Hall

While we try very hard to honor residence hall requests, your choice here does not guarantee that you will be placed in that building. Leaving blank signifies that you have no preference.

ID Picture 1 ID Picture 2 ID Picture 3

As in the documents above marked in yellow, your ID number can be located on multiple forms received via mail.

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