Services

On-Line Application
After filling the details click on the SUBMIT button.

* indicates required fields

*Name:

*Address:

*Phone:

*Moblie Phone:

*Major:

*Year:

Freshman
Senior

*Type of room interested in:

1 Bedroom
2 Bedroom
3 Bedroom
4 Bedroom

*Parent Name(s):

*Parent Address(es):

*Parent Phone Number(s):

*Student email address:

*Semester:

Fall 2010
Fall & Spring 2010-11

*Do you smoke?:

Yes
No

*Describe your personality:

*My house keeping habits are:

*What time do you wake up?:

*What time do you go to sleep?:

*Hobbies/Interests/Activities:

*Are you/will you be a registered full-time student:

Yes
No

*Have you ever been evicted?:

Yes
No

*Have you ever been dismissed from any college?:

Yes
No

*Have you ever been convicted of a felony?:

Yes
No

*Current GPA:

*Car Information:

*In Case of Emergency Contact:

*Room-Mate Request:

*Other Info:

After filling the details click on the SUBMIT button.

650 West German St. Herkimer, NY 13350 (315) 717-0031

Office Hours Monday-Friday 10:00am -2:00pm or by appointment