EmailMe Form - Saint Augustine's University Housing Application

Personal Information and Demographics

Student Name: *

First Last

Student ID Number *

Date of Birth *

MM / DD / YYYY

Phone Number *

### - ### - ####

Gender *

Male

Female

SAU Email Address *

Personal Email Address *

Address

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

Major and Classification

What is your classification: *

Freshman (First time in College)

Sophomore

Junior

Senior

What is your major? *

Emergency Contact Information

Emergency Contact Name: *

First Last

Emergency Contact Phone Number: *

### - ### - ####

Emergency Contact Email: *

Relationship to the Student: *

Room and Roommate Request

All roommate requests must be mutual and are based on room and floorplan availability. Requests will be processed once both or all parties have completed their housing application, and paid their non-refundable $200 housing application fee.

Roommate Request Name #1:

Roommate Request Name #3:

Roommate Request Name #2:

Special Housing Request: