HOUSING LOTTERY FORM

Student Name*
First Last
Student ID*
Class*
What will be your grade classification?
Please indicate your housing preferences below by listing the residence hall or apartment, room number, and preferred roommates in order from 1-3 in priority if you are requesting a space in the apartments. If you request an apartment and do not have roommate options, we will house you with who is available.
Choice 1
Residence Hall:
Room Number:
Roommate(s):
Choice 2
Residence Hall:
Room Number:
Roommate(s):
Choice 3
Residence Hall:
Room Number:
Roommate(s):
By typing your name below, you acknowledge that this form is a preference request, and you may not be placed in your first choice. We will honor preference as we can and based on the priority list from Pioneer Planning.
Student Name*
First Last
Serves as your signature

Choice 1