First Name:          

Last Name:          

Longwood ID #:   L

Date of Birth:      

Gender:               Select One: Male Female

Longwood Email Address*:

Local Address:

Street/Box:    
City:              
State:             
Zip Code:        

Permanent Address:

Street/Box:    
City:              
State:            
Zip Code:       

Cell Phone Number:   

Please indicate your residence hall or apartment community preference below (enter a number from 1-12):

ARC
Stubbs
Curry
Frazer
Cunninghams
Cox
Wheeler
South Ruffner (Single Room)
French
Longwood Village
Lancer Park
Longwood Landings

Specialized Housing: YES NO
if YES - please contact Disability Support Services (434.395.2391 x 711 {TT Relay})

Specialized housing requirements

Mutual Roommate Request: YES NO

Mutual 1:
Mutual 2:
Mutual 3:

Please note that both students must preference one another in order for RCL to attempt to match roommates.

By submitting this Housing Preference Form, I am officially asking to be provided housing and a meal plan, during the indicated summer period. I authorize that all associated charges be applied to my student account. I understand that I am financially responsible for making timely payment, prior to the start of the Fall 2010 residential student move-in date.

I further understand that I am financially responsible for any damages that occur within my assigned space/area.

I understand that RCL will verify all the information on this application and intentionally falsified information will be considered a violation of the Longwood University Honor Code.

Select "Yes" to agree to terms and continue YES