Hampton University - Summer Programs

Application for Residence Hall

INSTRUCTIONS

Send this application to:
Director of Summer Session
304 Wigwam Building
Hampton University
Hampton, Virginia 23668

Date:	SSN:

Miss Mrs. Mr.	Last Name: First Name: Middle Name:

Address: (Mailing address prior to opening of Summer Session)

Telephone #:	Age:	Field of study:

Physical Disability Yes: No: Describe if yes:

In case of emergency, who should be contacted?
Address:		Relationship:
Telephone #:

Have you ever been a resident student at Hampton University? Yes: No: If so, when?

Do you have a choice of roommate? Yes: No: If so, whom?
Do you smoke? Yes: No:
Check Current Status:		Indicate Session(s) you plan to attend:
Graduate Student		Session I (June 3-June 27) (4-wks session)
Undergraduate Student		Session 2(June 17-July 25) (6-wks session)
Pre-College/Summer Bridge		Session 3 (June 30 --July 25) (2nd 4-wks session)
Special (Non-HU Student)		Pre-College / Summer Bridge (June 20-July 25) (5-wks session)