Housing Application and Agreement Form Howard Payne UniversityStudent LifeHousing and Residence LifeHousing Application and Agreement Form The concept of on-campus housing at Howard Payne University embodies much more than an assignment in a residence hall. The residential community is an integral part of the university. Residence within this community implies certain obligations and standards of citizenship. Thus, a large measure of responsibility is delegated to residents in the areas of social life, extracurricular activities, conduct and the protection of university property. Violation of university polices and regulations may result in disciplinary action and/or termination of this agreement. Students are advised to acquaint themselves with the Student Handbook and the Howard Payne University Catalog prior to moving into campus living facilities. The university complies with all applicable federal and state nondiscrimination statutes and does not engage in prohibited discrimination on basis of race, creed, color, national or ethnic origin, sex, religion or handicap. In certain circumstances, Howard Payne University may exercise the authority to interpret, revise, extend, or grant exceptions to this agreement on the basis of need and merit of individual cases. **Fields in red are required** First Name * Last Name * Name I prefer to be called (if different) Are you a NEW or RETURNING student to HPU? * New student Returning student Email * Street Address * City * State * Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Street Address * What is your high school name & city? * Semester you plan to enter * Fall Spring May Term Summer I Summer II Academic year for which you are applying * 2015-2016 Are you a Transfer Student? * Yes No Gender * Male Female HPU Student ID # (If Known) Date of Birth (MM/DD/YYYY) * Cell Phone Permanent Phone * Emergency Contact Name * Emergency Contact Phone * Emergency Contact Work Phone * Classification * Freshman Sophomore Junior Senior Residence Hall Preference Veda (Women Only) Jennings (Men Only) Taylor (Men Only) Roommate Request (Must Be Mutual) Meal Plan * #1 (Unlimited meals per week/$100 Jacket Bucks/$125 Stinger Bucks) - $2221.80 #2 (15 meals per week/$150 Jacket Bucks/$125 Stinger Bucks) - $2150.36 #3 (12 meals per week/$200 Jacket Bucks/$125 Stinger Bucks) - $2061.59 Do you require any special housing accommodations because of a disability? * Yes No If yes, please explain. * Have you ever been convicted of a crime, or are there charges currently pending against you? * Yes No If yes, please state where, when and the nature of the offense. * I acknowledge that I am required to be vaccinated against bacterial meningitis at least 10 days prior to moving onto campus. (See Health Form for more details) * Yes No (Due to Exemption) Personality Profile Do You Facebook? * Yes No Major or Intended Major * Accounting Academy of Freedom Art Athletic Training Bible Biblical Languages Biology Business Administration Business Chemistry – Standard Chemistry – Biochemistry Christian Education Christian Studies Communication Studies Computer Information Systems Criminal Justice Cross-Cultural Studies Education Education – Elementary (EC-6) Education – Middle School (4-8) Education – High School (8-12) Education – All-Level (EC-12) English Engineering Science Exercise and Sport Science Family Studies Forensic Science General Studies History Interdisciplinary Studies Liberal Arts and Sciences Liberal Arts-Undecided Mathematics Management Management Information Systems Marketing Music Music – Church Music and Worship Music Education – All-Level (EC-12) Music – Piano Pedagogy and Accompanying Music – Performance: Instrumental Concentration (Non-Keyboard) Music – Performance: Organ Concentration Music – Performance: Piano Concentration Music – Performance: Voice Concentration Nursing Political Science Practical Theology Psychology Social Studies Composite Social Work Spanish Studio Art Theatre Youth Ministry Master of Arts in Youth Ministry Master of Arts in Theology and Ministry Master of Business Administration Master of Education in Instructional Leadership Tentative Career Plans Activities in which you plan to participate at HPU (Use Ctrl+Click to select multiple) Baptist Student Ministry Student Government (SGA) Choir Band Theatre Student Activities Council (SAC) Intramural Sports Athletics - Baseball Athletics - Basketball Athletics - Football Athletics - Golf Athletics - Soccer Athletics - Softball Athletics - Tennis Athletics - Volleyball Community Service Service Clubs Special Interest Clubs Fraternities/Sororities Favorite Music Favorite Sport(s) Favorite TV Show Do you like to read? Yes No Preferred Kinds of Reading Do You Like to be Around Other People? Yes No Most Influential Person(s) in Your Life Hobbies or Interests I would describe my housekeeping habits as: * Orderly Casual Messy I prefer to study during the: * Day Night Either/Both When I study, I prefer: * Silence Music or TV I almost always go to bed before midnight on weekdays: * Yes No I almost always get up before 7:00 am on weekdays: * Yes No I snore: * Yes No Sometimes I need at least ___ hours of sleep nightly. * 6 7 8 9 My interest in pursuing my walk with Jesus Christ is: * Strong Moderate No Interest In my family, my birth order is: * Only Child Oldest Middle Youngest List any illnesses, medications, or disabilities limiting activities: (If none, put N/A) * I would describe myself as: * The qualities I most desire in a roommate are: * Any other information you would like to provide us? Verification of Housing Agreement This is an agreement between Howard Payne University and the named student, and with the parent or guardian of the student if the student is under eighteen years of age, for a residence hall assignment only. It does not constitute a commitment of admission to the University. This agreement may be terminated only under the conditions specified herein. Students and parents/guardians are urged to carefully read this agreement. When this form is completed and returned to the Office of Student Life, it becomes a binding agreement between the student (the parent or guardian if the student is under 18 years of age) and the University. Howard Payne University requires full-time, unmarried students between the ages of 17 and 22 who are not living with parents to live in a University residence hall for four (4) full semesters (i.e., fall and spring semesters) until 60 verifiable credit hours are completed or the student reaches 22 years of age. Students under the age of 17 are restricted from living in University housing. University housing is reserved for students who are registered as full-time students (12 or more semester credit hours). This agreement is binding for the full academic year, does not guarantee assignment to a particular room or residence hall, and is binding regardless of the room assignment.