Salem University - University Housing Application

This application does NOT admit you to the University. Application for admissions to Salem University must be made separately. Advanced registration and housing deposit must be paid prior to submitting this form.

Application

Payment

Confirmation

First Name

Middle

Last Name

Gender

Birthday

Email Address

Academic Information

Are you a Transfer Student?

Class Standing

Applying For:

Month

Will you be a student athlete at Salem University?

Permanent Address Information

United States or International:

Address

City

State

ZIP Code

Home Phone

Work Phone

Emergency Information (in case of emergency contact)

United States or International:

Address

City

State

ZIP Code

Emergency contact phone:

Roommate Preferences

Is there someone you already have in mind as a possible roommate? If so, please list the name. We will try to honor you request.

Specific roommate name:

(Remember, roommate requests must be mutual. If a roommate is not requested, one will be assigned.)

Are you a smoker?

Do you object living with a smoker?

When do you go to bed?

Which best describes you?

Would you describe your housekeeping habits as?

Check to agree with the below statement.

I understand that acceptance of this application does not guarantee assignment to a residence hall or admission to the University. I have also read and understand the terms of this application as stated under Residence Halls Policies.

NOTICE: There is a $100.00 non-refundable fee to reserve your room at Salem. You may make this payment using a credit card by calling the Salem Business Office at 304.326.1310 or by sending a check or money order to Salem International University, attn.: Housing, 223 W. Main St., Salem, WV 26426.

Credit Card Information

Name (Payer)

Billing Address

Billing Address 2

City

State

ZIP Code

Country

Credit Card Number:

Credit Card Expiration:

Card Security Code (CVC):