Department of Residential Life
New Student Questionnaire

Last Name:

First Name:

MI:

Address:

City:

State:

Zip:

Mailing Address:

City:

State:

Zip:

Home Telephone:

Emergency Contact:
Must have a phone number in addition to your home phone where we can reach someone in case of an emergency.

Contact #1:		Contact #2:
Name:		Name:
Street:		Street:
City:		City:
State:		State:
Zip:		Zip:
Phone:		Phone:

Entrance Status: Freshman Transfer

Date of Birth: Format: mm/dd/yyyy

Sex: Male Female

Will you register a vehicle on campus?

Personal Information

I live with: Mother & Father Mother Father Other Relatives Other

My family consists of: Brothers Sisters

My home is in an: Urban Suburban Rural

I have held the following leadership positions:

My special talents, hobbies or skills are:

My greatest personal achievement to date has been:

I perceive my personal strengths to be:

I perceive my personal weaknesses to be:

PERSONAL DEVELOPMENT ACTIVITIES

Please select any item/issue, which you would like to address as you enter your first year of college.

PERSONAL INTERESTS

A variety of clubs, organizations and activities are available to students. Please check those in which you may have an interest. You will be contacted by club leaders or department concerning organized meetings.

Department of Residential Life New Student Questionnaire

Department of Residential Life
New Student Questionnaire