Apply

Email (please make sure it's absolutely correct otherwise we cannot get a hold of you) *

Gender *

Male Female

Date of Birth (mm/dd/yyyy) *

Where are you from? *

What is your major? What year are you in? Undergraduate or Graduate student? *

Tell us a bit about yourself. What do you like to do outside of school? What are your hobbies or interests? What type of work do you want to do after graduating? Etc *

What period are you looking to live with us and able to pay for? *

School Year (August 1 to May 31) Summer and School Year (June 1st or after to May 31) Fall (August 1 to December 31) Spring (January 1 to May 31) Summer (June 1 to July 31) Summer (June 1 to August 15th)

If you are looking to stay for a time period not specified above, please indicate your preferred start and end dates. *

If your preference is not available, are you willing to take any availability? *

Yes No

Are you receiving financial support from your family? *

Yes No, I am financially independent.

If you are receiving financial aid from your family, please indicate your co-signer's name *

First

Last

If you are financially independent, what is the source of your funding that you will us to pay for living with us at Regent House? Financial Aid, grants, jobs, money in the bank? Please give details. *

Are you a smoker or vapor? (We are a non-smoking non-viping home) *

Regent House’s terms of residency include being considerate and respectful behavior at all times, keeping common areas clean, do your dishes and keep your doings in the kitchen clean for others, being quiet so others can sleep, no sexist or racist language, no intoxication, no illegal activity, and similar policies. Do you agree? *

Yes, I agree to be considerate and respectful of my fellow housemates, want to live in this kind of environment, will do my part to create our living environment, have read the policies page of this website, and will adhere to the terms of residence. No, I might not be able to keep to these policies.

Regent House can introduce you wonderful roommate(s). But if you are looking to share with someone in particular, we'd really like to make that happen for you. Please indicate their name(s) here. *

Have questions? Please ask us here. If you would like to add something, please do so here. *

What is your height (for correct bed considerations) *

Emergency Contact Information: Please provide the name(s), relationship(s), and email address(es) of the people to contact on the very off chance that we need to be in touch with them. *

How did you learn about Regent House? *

If you selected "Other" above, please state how you learned about us. Thank you. *

Application to Live at Regent House