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Housing Application

By filling out the housing application a $50.00 non-refundable fee will be added to your Lake Region State College student account.

Summer 2014 Printable PDF Housing Application

Printable PDF version

 
First Name*
Middle Initial
Last Name*
Address*
City*
State*
Zip Code*
Daytime Phone*
Email Address*
Birth Date*
Area of Study*
Gender*
Room Preference*
If interested in an apartment, please see Shilkin Apartments
Please explain if you have special accommodation needs:
Roommate Request
Housing Status*
Food Service Meal Options*
Plans include $110 flex cash per semester and may include weekend brunch.
Term Entering*
Year Entering*
Emergency Contact*
Relationship to Emergency Contact*
Emergency Contact Phone Number*
Have you been convicted of a felony and/or have a sex offender status?
I agree that to the best of my knowledge the information on this form is true and complete without evasion or misrepresentation. I understand that if found to be otherwise, it is sufficient cause for rejection or dismissal.
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