Summit Village Housing Application-Spring 2013 ONLY

This application will not submit the Housing Application online, it is a form that you fill out, and then print.Please answer the following set of questions, and then hit ‘Generate Application’ at the bottom of the page.  If you have filled out the application correctly, you will receive a confirmation page.  Print this page, and return it to the Residence Life and Housing Office.

Personal Information
*First Name
Middle Name
(leave blank if no middle name)
*Last Name
Preferred Name or Nick Name
(leave blank if does not apply)
*Date of Birth 
(mm/dd/yyyy)
*UCCS Student ID Number
(no dashes)
*Gender
*Expected Class Standing
Current or Proposed Major
Mailing Address
*Street
*City
*State
*Zip
Additional Contact Information
*Home Phone Number
*Cell Phone Number
*Email Address
Emergency Contact Information
*Name of Parent
or Guardian
*Name of 
Emergency Contact
*Emergency Contact
Phone Number
Term of Contract
*Length of Contract
Housing Request
Roommate(s)
(This needs to be a specific person, not a major or other type of preference)
*I would prefer
to have roommates
that do not smoke
(Please note that all housing facilities are non-smoking, however we understand that some people have concerns living with students that do smoke outside of the facility)

We have rooms designed for students with special needs.  Please let us know if you need a specific room type due to a documented disability.
*Special Needs
(Students who request accessible rooms will be referred to the Office of Disability Services)
Room Type Preferences
Please rank in order from 1 (being first choice) to 4 (being last choice).  If you do not fill out a preference, you will be placed in a double occupancy as your first choice.
*Shared Bedroom in a Suite
*Private Bedroom in a Suite
*Private Bedroom with a Private Bath
*Special Interest Floor
Use the Drop Down Menu to Select a Special Interest Floor.  See the Summit Village Web Site for Details.
Meal Plan Request
*Meal Plan

If you would like to add additional Munch Money, you may do so with your application so it is set up for the beginning of the semester.  This will be billed to your student account.
Munch Money
Final Instructions
Please check all of your information. After hitting 'Generate Application', you will be taken to a confirmation page. This includes your application information, and your Housing Agreement, which is your contract with the Office of Residence Life and Housing. Print off this information, sign it, and return it with your $300.00 application fee and deposit.
* denotes required field