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Student Life
Student Housing

Undergraduate Summer Housing Participation Form

Summer housing will be available to all undergraduate students currently residing in the Regent Commons or Regent Village.

Student Name*
First Middle Last
Banner ID#*
Class Rank*
- Freshman
- Sophomore
- Junior
- Senior
Current Housing Assignment (Building/Rm. #)*
Gender*
- Male
- Female
Date of Birth*
MM
DD
YYYY
Room Preference #1*
Room Preference #2*
Room Preference #3*
Requested Roommate
Roommate requests must be mutual in order to be considered for assignment by Residence Life staff.
Phone Number*
Regent Email*
Reason(s) for Summer Housing*
Check all that apply.
- Select All
- On-Campus Courses
- Campus Employment
- University Approved Internship
Number of registered credits*
Must be at least one on-campus class for the summer term.
Campus Employer*
Employer Phone*
Academic Advisor*
Advisor Phone*
By signing and submitting this form you are indicating that you plan to reside in on-campus student housing for the summer months of 2021 (May - August).

By NOT signing and submitting this form you are agreeing that you will NOT have a 2021 summer campus housing assignment.
Signature
Date*
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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EQUAL OPPORTUNITY POLICY FOR STUDENTS Regent University does not discriminate on the basis of race, color, sex, national or ethnic origin, disability, age or veteran status in admissions, treatment or access to its programs and activities, or in the administration of educational policies, scholarships, loan programs, athletics or other University programs. In addition, Regent does not discriminate based on religion, except as necessary to comply with Regent’s Standard of Personal Conduct and Statement of Christian Community and Mission.

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