Housing Application Form

Application For:
 

First Name:
Middle Name:
Last name:
DOB (mm/dd/yyyy):
Gender:
Classification:
Email:
Home Telephone:

 
Permanent Address:

Street Number:
City:
State:
Zip Code:
Country:

Meal Plan:

Would you like to be contacted with information regarding rooms for students with disabilities?

Questions & Assistance:
 For additional information about available services and features or assistance with completing this application e-mail: residence.life@atu.edu
 

Important Information:

  • A $25.00 non-refundable application fee is required with this application. This fee should be mailed to: The Office of Residential Life, Arkansas TECH University, 229 "Doc" Bryan Student Services Building, Russellville, AR, 72801. Please make a notation on your check that you have submitted an electronic application as well as your birth date.
     
  • The reservation fee is required of each applicant, but receipt of the fee does not guarantee a room assignment. The reservation fee is non-refundable.
     
  • A Residence Life Contract will be mailed to you. Upon receipt of the contract, you must sign and return the contract and pay a $50.00 pre-payment before a housing assignment will be made.
     
  • Students will receive written notice of their residence hall assignment. Assignments will be honored until 12:00 noon of the opening day of the semester involved. Students arriving at their residence hall after the 12:00 noon deadline will be offered rooms if available.
     
  • If you have any questions regarding this application or housing concerns please feel free to contact the Office of Residential Life.
     
  • For the purpose of health, safety, privacy and for the normal operation of the residence halls, residents must be 18 years of age or older by September 1 of the year under contract. The Vice President for Student Services may grant a waiver of the minimum age based on extenuating circumstances.
     
  • Please note that Roommate and Hall Preference is strictly a requests. No guarantee of these requests can be made by the Office of Residential Life or any other office on the Tech campus.

Acceptance of Terms and Conditions:
 I have read and agree to abide by the above provisions.