Residential Status Agreement

Social Security Number:
Date of Birth Age:
Name of Student:
Mailing Address:
City: State: Zipcode:
Home Phone
Cell Phone
E-Mail Address:
Emergency Contact Information:
Phone Number:
Home Church: (NA if unknown)
Telephone Number:
City: State:
Session applying for:
Contract for school year
NOTE: Community living in our residence halls is designed for the traditional-aged undergraduate student. Graduate students and those students over the age of 25 will only be allowed to live in the dorm if space is available and approved by the Housing Exception Committee.
I plan to live in NNU Campus Housing (Also, I hereby agree to occupy a room in the residence hall assigned to me for the period indicated above at the rate prescribed by the Board of Trustees of the University for board and room for the term of this contract.)
     Residence Hall and/or Room Desired:
  Name of Roommate (optional):
  I prefer a single room if available ($250 additional per semester). Single rooms not available in the apartments.
I will not be living on campus because I meet one of the following criteria: (Please skip to the bottom of the page if completing this question.)
  I am 22 years of age or older and/or have senior credit standing. *
  I am married and/or have a child.
I do not meet the above criteria but want to request to live off-campus due to special circumstances. (Requires approval by Exceptions Committee).*
*Requires an application for off-campus housing which will be sent after the $250.00 deposit is received.

  1. Intended major:
  2. Would you like to be considered in being matched with an international student as a roommate?
      Yes No
  3. If you are playing a sport at NNU, which one?
  4. How would you rank your personality on the scale below?
    Introvert 1 2 3 4 5 6 7 8 9 10 Extrovert
  5. What types of music do you listen to?
    Heavy Metal Reggae Classical Rock
    Rap Pop Christian Indie
    Country Jazz Alternative  
  6. Name some of the hobbies you enjoy:
  7. How clean do you keep your room?
    Pig pen 1 2 3 4 5 6 7 8 9 10 Surgical Table
  8. Are you a late night or early morning person?
    Night Owl 1 2 3 4 5 6 7 8 9 10 Early Bird
  9. What is your organizational style?
    Laid Back 1 2 3 4 5 6 7 8 9 10 Structured
  10. How do you like your study environment?
    Totally quiet 1 2 3 4 5 6 7 8 9 10 Study with the radio/TV on
  11. I agree or disagree with the following statements:
    a. It's OK to borrow items without permission agree     disagree
    b. Visitors are welcome in my room at all times agree     disagree
    c. Roommates should share activities and interests agree     disagree
    d. I prefer to study in the library, not my room agree     disagree
    I agree to obey the Terms and Conditions of Occupancy attached, as well as the rules, regulations and policies governing the conduct and lifestyle of students which are now in effect, and any that may be adopted and approved by the University during the period of this contract.