First Name:
Middle Name:
Last Name:
Local Address Fields:
Street Addess:	Include Apt #
City:
State:
Zip Code:
Personal Information Fields:
Shaw Student ID:
Sex
Home Phone:
Cell Phone:
Email Address:
Although smoking is not allowed in University Housing, to assist the Residence Staff in evaluating room assignments, it is imperative that we are aware as to whether or not you smoke. Unless you pay an additional $1,505.00 for two beds, you will be assigned a roomate. Roomate Request :
Requested Roomate Name :
Requested Roomate Name :	(3 Party Room)