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:(Last four numbers only)
Miss Mrs. Mr.
Last Name:		First Name:
Middle Name:		Telephone #:
Address(Mailing address prior to opening of Summer Session):

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 (May 31 - June 27) (4-wks session)
Undergraduate Student		Session 2 (June 13 - July 22) (6-wks session)
Pre-College/Summer Bridge		Session 3 (June 28 - July 22) (2nd 4-wks session)
Special (Non-HU Student)		Pre-College / Summer Bridge (June 17 - July 22) (5-wks session)