EmailMe Form - Housing Reservation Form

Enrollment status *

New Freshman

New Transfer

Readmit

Returning

Graduate

(Freshman and sophomore students must live on campus unless they meet criteria outlined in the Housing Waiver Application.)

Semester Enrolling *

Fall

Spring

Year Enrolling *

Student Information

Shaw Student ID # *

Gender *

Male

Female

Date of Birth *

MM / DD / YYYY

Name *

First Middle Last Suffix

Email *

Permanent Mailing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Primary Phone *

### - ### - ####

Mobile Phone *

### - ### - ####

Parent/Guardian Name *

First Last

(This information will also be used as Emergency contact.)

Contact Phone *

### - ### - ####

Roommate Request

Roommate pairing is done randomly, however, if you have a roommate request, we will try to honor it. Both parties must request the other person on their housing application and submit housing reservation form and non-refundable fee by the deadline for the semester applying. Specific rooms may not be requested.

Name

First Middle Last

Student ID #

(Student ID of requested roommate)

Do you have medical concerns that we should be made aware of prior to assigning your room for the semester? *

Yes

No

Please state medical concerns/issues? *

Documentation from a health care provider must accompany any requests for special accomodations at the time of application.

Do you smoke? *

Yes

No

Please note that smoking is prohibited in the residence halls.

Are you currently a member of a Shaw University athletic team, Platinum Sound Marching Band or Honors College? *

Athletic Team

Platinum Sound Marching Band

Honors College

None

Please select all that apply.

Which sport do you play? *

Are you currently 18 years or older? *

Yes

No

Application certification *

I certify that all information provided is true to the best of my knowledge

Student Digital Signature *

First Middle Last Suffix

Parent Digital Signature *

First Middle Last Suffix

Required if student is under 18 years of age at time of application

Payment Options *

Submit Secure Online Payment via Debit/Credit Card

Payment Previously Submitted

Payment Transaction Number

Date Time

MM / DD / YYYY