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Campus Life

Housing Form

Need to view or edit your existing housing application? Review yours at housing.central.edu.

Personal Information

Student Information

First name:

Middle initial:

Last name:

Preferred name (Nickname):

Home address:

City:

State/Province:

Zip/Postal code:

Cell Phone number – Including area code:

Birthdate (Month/Day/Year):

Gender:

Parents Information

Mother's name:

Father's name:

Meal Plan Selection

Meals per week:

Enrollment Information

I am a …

Entering semester:

Residence Hall Preferences

All first year students will be placed in residence halls. Assignment preferences are honored in order of housing application date received. Specific room accommodations may be requested at the end of this housing form but are not guaranteed.

If you need help with housing, review current housing options that we offer on campus.

Dorm Choice Rankings

In order to continue, please answer "Gender" and "I Am A …" questions above.

First choice:

Second choice:

Third choice:

Fourth choice:

Fifth choice:

First choice:

Second choice:

Third choice:

Fourth choice:

Fifth choice:

First choice:

If you chose Townhouse, what Townhouse do you prefer?

Second choice:

If you chose Townhouse, what Townhouse do you prefer?

Third choice:

If you chose Townhouse, what Townhouse do you prefer?

Fourth choice:

If you chose Townhouse, what Townhouse do you prefer?

Fifth choice:

If you chose Townhouse, what Townhouse do you prefer?

Sixth choice:

If you chose Townhouse, what Townhouse do you prefer?

First choice:

If you chose Townhouse, what Townhouse do you prefer?

Second choice:

If you chose Townhouse, what Townhouse do you prefer?

Third choice:

If you chose Townhouse, what Townhouse do you prefer?

Fourth choice:

If you chose Townhouse, what Townhouse do you prefer?

Fifth choice:

If you chose Townhouse, what Townhouse do you prefer?

Sixth choice:

If you chose Townhouse, what Townhouse do you prefer?

Physical or Health Conditions

Please specify if you have any physical or health condition(s) which require special attention:

I require air conditioning:

Students who request a room with air conditioning will be assigned to Scholte or Graham Halls. Documentation from a physician will be required to show need.

Roommate Matching Data

Roommate Preference?

Roommate preference must be mutual and will only be honored if both applicants have paid deposits prior to May 30.

Do you smoke/vape?

Do you object to a roommate who smokes/vapes?

Central is a smoke free campus.

I feel most comfortable when my room is:

I consider myself to be a:

Hours of sleep I generally need each night:

When I study I:

I plan to do most of my studying:

The Types of Music I Listen To Most Often Are: (Check at Least 1)

Pop/Top 40	Christian Rock	Country
Alternative	Hard Rock/Metal	Rap/Hip Hop
Classical	Jazz/Blues	House/Dance/Club

I plan to major in:

Please list the co-curricular involvements, hobbies, and interests you have:

Would you like to live with someone with the same co-curricular involvement as you?

Which activity is most important?

Please share what you're looking for in a roommate, what you think is most important to you when matching with a roommate, and any additional information you feel we should consider as we work to assign you a roommate:

If you have a question about this form, please contact Chevy Freiburger, Dean of Enrollment Management, at 877-462-3687 or freiburgerc@central.edu.