Faulkner University  

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*Note: Required fields are in bold.

Personal Information

First Name: Middle Initial: Last Name:
Preferred Name: Date of Birth: Gender:
Classification: Select a semester:


First Name: Last Name:

Contact Information

Address: City:
Country:   State/Province:   Zip:
Phone: Cell: Email:

Emergency Contact Information

First Name Last Name Relation Phone
Contact One:
Contact Two:

Special Accommodations

Please list any special accommodations that you may require:

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Roommate Survey

Please fill out the profile below as the questions pertain to you.
Sport/Other Activity:
Personal Hours:
Study Habits:
Sound Level:
Room Climate:

Music Interests: Click All That Apply

If other, please list (comma separated please):

Additional Info

Please list your favorite activities/hobbies/interests:
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Religious Background:

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List any other info that you feel would help us placing you with an appropriate roommate:
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Roommate Request

Please answer all of the fields that apply.
First Name Last Name Roommate Status
Roommate One:
Roommate Two:
Roommate Three:

Payment Options

There is a $50.00 housing reservation fee for new students & transfer students.
Payment Information
Payment Amount: $50.00
Card Type:
Card Number (No dashes or spaces):
Security Code (What's this?):
Exp Month / Exp Year:  /
Name (as it appears on Credit Card):
State / Province:
Zip Code: