Housing Application

Indicates required fields.

Personal Information
First Name:
Middle Name:
Last Name:
Street Address:
City:
State:
 Zip
Phone (Home):
(xxx) xxx-xxxx
Phone (Work):
(xxx) xxx-xxxx
Email Address:
Employer
Enter "NA" if not employed
Have you ever
been enrolled at
MSU, CWV, or
Beckley College?
If yes, when? 
Birth Date:
mm/dd/yyyy
Social Security Number:
xxx-xx-xxxx 
*International Students enter 000-00-0000*
Gender:
Emergency Contact Information
Person to contact
in case of emergency
Phone
(xxx) xxx-xxxx
Relationship
Academic Information
Applying for Term Beginning
Full or Part Time>
Classification at Beginning of Term
Intended Major
Housing Preference
First choice
Second choice
Have you ever been
convicted of a felony?
Explanation if yes 
Have you ever been convicted
of a crime that would
require you to register
as a sex offender?
Explanation if yes 
Roommate Preference
Do you prefer a roommate who is___ (Scale: 1 = very, 5 = not at all)
Quiet/Reserved
Outgoing
Neat/Orderly
a Morning Person
a Night Person
likely to prefer quiet hours to study
studying in a similar major
from a similar geographic area
Request a specific roommate
By submitting this form you are acknowledging that you have read and understood the Residence Hall Terms.
Note: All efforts are made to accommodate requests but there is no guarantee that all requests will be fulfilled.
Note: Mountain State University reasonably accommodates persons with disabilities. Please contact the Housing and Residence Life Office for additional information. This application does not admit you to the University. After submitting this housing application, you must send the required nonrefundable $100 housing application fee (unless you are applying for exemption), payable to Mountain State University, to the Housing and Residence Life Office, 410 Neville Street, Beckley WV 25801. We cannot accept checks drawn on international banks.

Please click the Submit button only once.