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 (June 1-June 26)(4-wks session)
Undergraduate Student	Session 2(June 15-July 24)(6-wks session)
Pre-College/Summer Bridge	Session 3 (June 29 --July 24)(2nd 4-wks session)
Special (Non-HU Student)	Pre-College / Summer Bridge(June 19-July 24)(5-wks session)