Waitlist Room Application

Applicant Information
Last Name: First Name: Mid Init:
Home Address:
Street address, P.O. box, c/o

Apartment, suite, unit, building, floor, etc.
City:
State (USA only):
ZIP/Postal Code:
Country:
E-mail Address:
Local Phone Number:
Campus Mailbox:
Hartwick Student ID:
Gender: Female Male
GPA:
Graduation Date:

Housing Preferences:
Type of Room:
Please number your preferences, with 1 as your first choice. Leave blank if you have no preference.
Single Room
Enhanced Single
Double Room
Suite
Triple Room

Residence Hall:
Please number your preferences, with 1 as your first choice. Leave blank if you have no preference.
Hilltop
Holmes
Leitzell
Oyaron
Pine Lake
Saxton
Smith 1
Smith 2
Townhouses
Van Ess
Wilder

Roommate(s):

If you feel that there is additional pertinent information that we should be aware of, please explain:

I understand that I am responsible for the additional cost for a single room, enhanced single room, or suite accommodations.
I further understand that if I have been granted approval for a single room, I must reapply for each new academic year.
The housing office will assign me according to availability.

Student Signature:

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