Form

Anderson University Housing Agreement
Student Information
Student Name*
First Name Middle Name Last Name
AU Student ID#*
Gender*

Female Male
Student Classification*
Anticipated Start Date*

Permanent Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Student Birth Date*
Month Day Year
Anticipated Major*
Student Home Phone*
- Area Code Phone Number
Student Cell Phone*
- Area Code Phone Number
AU Student Email*
Parent or Guardian Information
Primary Guardian(s) Name(s)*
First Name(s) Last Name
Relationship to Student*
Guardian Home Phone*
- Area Code Phone Number
Guardian Cell Phone*
- Area Code Phone Number
Emergency Contact Information
Emergency Contact*
First Name Last Name
Relationship to Student*
Emergency Contact Phone*
- Area Code Phone Number
Would you like to complete the personal interests and preferences section for roommate matching purposes? If you already have a confirmed roommate you do not need to complete this section.*

Yes No
Personal Interests and Preferences

Please complete this section to help our staff with the assigment process. We will utilize this information to match you with roommates and/or suitemates.
Check all activities you may like to participate in while at Anderson.

Student Government Campus Ministry Performing Arts (Music, Theater) Community Service Campus Leadership Intramural Sports Multicultural Activities Art or Photography
I plan to be a varsity athlete:*

Yes No
What sport(s)?*
In the morning I prefer to:*

Wake up early Sleep in late
At night I prefer to:*

Go to bed early Stay up late
I keep my room:*

Spotless Somewhat clean Not very clean
I attend church:*

Regularly Sometimes Almost Never
I study with TV or music*

On Off
Check all music preferences

Christian or Gospel Pop/Rock Rap/R&B Country Classical/Jazz Alternative or Metal
I smoke:*

Yes No
I am okay with a roommate who smokes:*

Yes No
My room should be:*

Primarily open to friends or guests Primarily for studying and sleeping
On the weekends I will likely:*

Stay on campus with friends Go home to see family or friends Do both equally
I am interested in living with an international student:*

Yes No
Current students may choose their building and roommate(s) during current student housing sign-ups in April. If you are a current student and will NOT be participating in this process, you may list building and/or roommate requests on this form.*

I am a current student who will choose my building and/or roommate during housing sign-ups in April. I am a current student who needs to make a building and/or roommate request.
Building and Roommate Requests
In selecting your building preferences, you will only see those buildings for which you meet the gender and student classification requirements. You are required to select a "first choice". You have the option to select a "second" and "third" choice.

Anderson University operates with a tiered pricing structure for university housing: Tier I through Tier V, with Tier I being the most expensive and Tier V being the least expensive. The housing rates for 2013-2014 are listed below.

Tier I: Village Private Room ($2,985/sem.; $5,970/year)

Tier II: Whitaker Hall; Denmark ($2,262/sem.; $4,524/year)

Tier III: Boulevard Halls; Pratt ($2,210/sem.; $4,420/year)

Tier IV: North Rouse; South Rouse; Village Basement ($2,158/sem.; $4,316/year)

Tier V: Lawton; Kingsley; Stringer; South Rouse Ground Floor ($2,106/sem.; $4,212/year)
First Choice-Freshman Males*
Second Choice-Freshman Males
Third Choice-Freshman Males
First Choice-Freshman Females*
Second Choice-Freshman Females
Third Choice-Freshman Females
First Choice-Upperclassmen Males*
First Choice-Transfer Males*
Second Choice-Upperclassmen Males
Second Choice-Transfer Males
Third Choice-Upperclassmen Males
Third Choice-Transfer Males
First Choice-Upperclassmen Females*
First Choice-Transfer Females*
Second Choice-Upperclassmen Females
Second Choice-Transfer Females
Third Choice-Upperclassmen Females
Third Choice-Transfer Females
Roommate Request #1 (Roommate requests must be mutual to be placed together.)
First Name Last Name
Roommate Request #2 (optional-if desired for triple rooms)
First Name Last Name
Roommate request deadline is May 1st for Fall and December 1st for Spring. If you do not have a specific roommate request, that is not a problem! Residence Life will work diligently to find the best match for you based on your personal preferences.
Meal Plan Options
All residential students are required to purchase a meal plan option below. Students have until the 3rd day of classes each semester to change their meal plan. Meal plan prices for 2013-2014 are included with the options.
Meal Plan Selection*
Housing Agreement Terms & Conditions

Please read the terms and conditions of this housing agreement carefully and provide the student e-signature below.
Housing Registration Pre-Payment: Prior to reserving a room or participating in the annual housing sign up process, returning students must pay a $100 housing pre-payment. (NOTICE: The housing pre-payment will increase to $200 for the 2014-15 academic year.) This payment must be paid in full and cannot be charged to the student account. This pre-payment is non-refundable (except in the unlikely event that campus housing is unavailable) and will be applied to the fall semester housing charge upon occupancy. All housing pre-payments should be made online through the Residence Life webpage.

Housing Requirement: We believe students experience greater personal and educational growth in campus housing. Therefore, Anderson University requires all freshman and sophomore students to live in campus housing unless the student meets one of the criteria listed under the "Residence Policy" in the Student Handbooklocated in the Student Life section of the University website.A residency appeal form may be obtained from the Residence Life website or office. The appeal must be submitted to Residence Life byMay 1st to be considered for review. Students living off campus who do not meet the proper criteria may be subject to disciplinary action and held financially responsible for the semester housing charge regardless of their current physical residence.

Assignment: Housing assignments for new students are processed on a "first come, first served" basis according to the date in which a student’s enrollment deposit was received. Assignments for returning students will be made in the spring semester during the annual housing sign-up process. Returning students who do not participate in the spring housing sign-up process will be placed on a waiting list to be assigned as space becomes available. The Residence Life Office reserves the right to reassign or consolidate residential students at any time if it is found to be in the best interest of the University. The University also reserves the right to assign students to temporary accommodations in the event that occupancy is exceeded.

Binding Agreement: This agreementis binding upon signing . The term of this agreement is for the Fall 2013-Spring 2014 academic year. However, the agreement can be terminated upon completion of the Fall 2013 semester without penalty.

Cancellation Policy: Returning students who wish to cancel their housing agreement must complete the Agreement Cancellation Form and submit it to the Residence Life Office prior to June 1 to avoid cancellation fees. Cancellations, for any reason, except academic ineligibility*, received after June 1 will result in forfeiture of the housing deposit and a cancellation fee according to the following schedule. Cancellation forms are located in the Residence Life section of the University website.

Cancellation Fee Schedule

After June 1                $200.00 and forfeiture of $250 Housing Deposit

After July 1                   $400.00 and forfeiture of $250 Housing Deposit

After August 1               $700.00 and forfeiture of $250 Housing Deposit

After September 3        Student is responsible for full semester of room charges,

                                    plus forfeiture of $250 Housing Deposit.

*A returning student who becomes academically ineligible after signing up for housing may be exempt from cancellation fees if he/she completes a cancellation form prior to July 15.

Late Arrival: Failure of student to occupy his/her assigned campus housing by the first day of classes may result in loss of the assigned space and cancellation fees being applied to his/her account.Students who plan to arrive after the first day of class, must submit a Late Arrival Notice (found in the Residence Life section of the University website) by the Sunday prior to the beginning of classes.

Termination of Enrollment: If a student's enrollment at the University is terminated during an academic term, the student must vacate university housing within 48 hours, or within 24 hours if the termination is for disciplinary reasons.

University Policies: All students in University housing are required to abide by the University's rules and regulations for student housing as they may exist from time to time. These rules and regulations can be found in the Student Handbook located in the Student Life section of the University website.
I have read and agree with the terms and conditions of this Housing Agreement.*

Yes, I understand and agree.
Is the student at least 18 years of age?*

Yes No
Student E-Signature*
First Name Last Name
Guardian of Minor E-Signature*
First Name Last Name
Please ensure that the housing agreement is complete and accurate before submitting. You will receive an email confirming our receipt of your Housing Agreement.
Should be Empty:

Anderson University Housing Agreement

Student Information

Parent or Guardian Information

Emergency Contact Information

Personal Interests and Preferences

Building and Roommate Requests

Meal Plan Options

Housing Agreement Terms & Conditions