Online Application

If you would like to apply for housing at Taylor Hall, please fill out the following form for our records. After applying, your information will be processed and kept on file until your fees are paid. For more information on fees, please see the Move-in Information page. You may also contact us at 510-284-1801.

Personal Information:

DSI#:

First Name:

Last Name:

Gender:

(Ex: MM/DD/YYYY)

Date of Birth:

/ /

Contact Information:

Permanent Address:

City:

State/Province:

Postal Code:

Country:

Home Phone:

() -

Cell Phone:

() -

E-mail Address:

Housing Information:

School:

Major:

Application Term:

Housing Status:

Housing Payments:

Emergency Contact Information:

Contact Name:

Relationship:

Address:

Phone:

() -

Alt. Phone:

() -

Room Assignment Preference:

Room Type:

Requested Roommate:

In order to help us place you with an appropriate roommate, please fill in the following
information about yourself and your lifestyle.

Do you smoke or use tobacco products?

*All campus facilities, including Taylor Hall, are smoke-free environments

Do you have a vehicle that you will be bringing?

What kinds of music do you listen to? (Please check all that apply)

Classical	Heavy Metal	Latin
Alternative	Hip Hop	Rap
Rock	Country	Jazz	R&B

What are your study habits? (Please check all that apply)

I study in my bedroom	I study in the living room	I study in the library
I study less than 1 hr/day	I study 1-3 hrs/day	I study more than 3 hrs/day
I study in the morning	I study in the afternoon	I study at night

Please evaluate yourself in the following three areas:

Cleanliness:
Socialness:
Sleeping Preference:

Please provide any additional information about yourself and/or your roommate preference:

Additional Background Information:

Have you ever been convincted of or pled guilty or "no contest" to any felony?

Have you ever been convincted of or pled guilty or "no contest" to a sexual offense?

If you answered "Yes" to either question, please explain below. Prior to moving in you must make an appointment to meet with the Dean of Student Central and the Manager of Residence Life.