ACADEMIC YEAR Applicants should understand that by entering into this housing agreement they are liable for the room and board charges for the full academic year (August-May) Academic Year Please select the semester and/or summer session from the list below. Fall Semester Spring Semester Other: Please specify Classification 1st Year Freshman Readmit Student Transfer Continuing Student Graduate Name Full Name Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016 Gender male female Mailing Address City State Zip Code Home Phone Cell Number Emergency Contact Name Relationship Home Telephone Work Telephone Cell Number Email Roommate/Hall Request Your Characteristics Academic Major/Interest Musical Preference - Type Music Volume loud average soft Do you smoke yes no Previous Colleges/Universities Attended Preferred Roommate Characteristics Morning person Late night person Same major Different major Extremely neat Messy and scattered Other Preferred Hall First Choice Belk (co-ed) Courtyard Apartments (co-ed) Cypress (co-ed) North (co-ed) Oak (co-ed) Pine (co-ed) Village Apartments (co-ed) 2nd Choice Belk (co-ed) Courtyard Apartments (co-ed) Cypress (co-ed) North (co-ed) Oak (co-ed) Pine (co-ed) Village Apartments (co-ed) Alcohol free yes no Name of Roommate Both students must request each other and have applications and deposits submitted. It may not be possible to grant requests received after June 1. RECEIPT # (required) A $150 deposit must be on file before a room assignment can be made. You will not be able to submit this online application without a receipt number. Please contact the Housing Office (910.775.4253) to pay by Credit or Debit Card . Please enter the receipt number below. Note: You can also mail the $150 deposit (check or money order, there will be a $25 fee chared for returned checks) with a copy of this application to: UNCP Housing and Residence Life PO Box 1510 Pembroke, NC 28372 Receipt # * Refund Policy of Room Deposit The University will refund all except $25 of the room deposit to incoming new students if written cancellation is received by July 31, preceding the fall semester, and by August 8, preceding the spring semester. The room deposit is non-refundable after these deadlines. SUBMISSION OF FORM By clicking the Submit button, I (student or Parent/Guardian if student is under 18 years of age) hereby certify that all information presented on this Housing Agreement is true. I have read this document in its entirety and understand the terms thereof.