Dorm 1

Dorm 2

Dorm

1st Floor

101

102

103

104

2nd Floor

201

202

203

204

3rd Floor

301

302

303

304

4th Floor

401

402

403

404

Dorm: - Room:

Dorm: - Room:

Name	Email	Gender	Building	Room	Student Id
Name	Email	Gender	Building	Room	Student Id

Name

Email

Street Address

City

State

Zip

Phone #

Gender

Date Of Birth

Student ID (8 Digits)

In which building do you wish to place the student?

Building 1

Building 2