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The Office of Residential Life: Online Housing Application
PERSONAL INFORMATION
First Name:
Last Name:
HSSU ID:
Sex:
Date of Birth:
Home address:
City:
State:
Zip:
Country:
E-mail:
Home Phone:
Mobile Phone:
Emergency Contact Name:
Emergency Contact Phone:
Alternate Emergency Contact Phone:
Do you need a room to accomodate a physical disability:
Are you a first-time freshman:
Room Type:
Occupancy to begin:

Have you ever been convicted of or plead guilty to a crime including, but not limited to, a felony or misdemeanor, or are any criminal charges now pending against you?

If so, please specify the nature and circumstances of the offense, the date it occurred, the name and location of the court and the sentence imposed. Please submit court documentation and parole officer contact information, if applicable.
 
Applicants may be required to go through an interview process and background check before being admitted to a residence hall. The Director of Residential Life will make all final decisions regarding admission to a residence hall and may impose conditions on the student’s admission to a residence hall.
   
EMPLOYMENT STATUS
Employer Name:
Employer Phone:
Employer Address:
City:
State:
Zip:
Country:
Position:
Gross Monthly Income:
Start Date:
Supervisor:
Supervisor Phone:
May we contact your employer?
   
VEHICLE INFORMATION
Make:
Model:
Color:
Year:
License Plate State:
License Plate Number:
Please submit your application along with the $175 (nonrefundable) application fee made payable to Harris-Stowe State University. Applications submitted without the application fee will not be considered. Please do not send cash. Once you have submitted this form, you will be directed to the online payment option. The application fee is nonrefundable should you cancel and or change your mind for any reason.
I certify that I am over 18 years of age and have read and understood the Harris-Stowe State University Housing Contract. If you are under 18 years of age, please print and fill out this application and have your guardian co-sign.
   
   
ROOMMATE REQUEST
Roommate requests and or assignments will not be processed until all applicable fees have been received. Due to space limitations, requests may not be honored. Please enter the first and last name of your roommate request.
Roommate 1:
Roommate 2:
Roommate 3:
Roommate 4:
Select the answer that best describes your preference
I typically wake before 6:30 a.m.
I go to bed before 11 p.m.
I consider myself to be an outgoing, social person.
I would like the opportunity to live with an international student.
I like all types of music.
I would like a roommate with similar hobbies. List:
I intend to be active in campus activities. List:
My major or areas of interest are:
I intend to participate in the following:
Baseball
Basketball
Softball
Soccer
Volleyball
Trivia Team
Choir
Theater
Cheer
Dance
 
   
   
   
   
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Harris-Stowe State University | 3026 Laclede Ave. | St. Louis, MO 63103 | (314) 340-3366

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