Last Name
First Name
Country Code	(for International Students only)
What academic program will you be enrolled in?
Gender
Current Address
Current Phone Number
Valid E-Mail
Housing Preference #1
Housing Preference #2
Housing Preference #3
There are a limited number of furnished apartments. Would you prefer furnished or unfurnished?	Furnished Unfurnished
Are you interested in living in a house where musical instruments are practiced?
If you have a spouse or domestic partner and/or children, please list them, their relationship to you, and their age in the space provided.
Approximate date housing is needed:	(mm/dd/yy)
Is there anything else concerning your housing that you would like our office to know when placing you?

IMPORTANT ITEMS:

Every effort will be made to meet your housing preference.
However, housing is provided on a space available basis.
To maximize our opportunity to serve you well,
please turn your application in as soon as possible.

Students will be notified of their specific assignment in mid July 2008.
Upon receiving notification of your assignment, you will be given the
opportunity to decline Wesleyan University housing prior to signing your lease.

If you have any questions, please contact Amy Miller in the Office of Residential Life at 860-685-3173 or e-mail at amiller01@wesleyan.edu