RESIDENCE HALL APPLICATION
PERSONAL DATA
Student ID
International Student
Male
Female
First Name
Last Name
Nickname
Home Address
Home Phone
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Cell Phone
Email Address
Birthdate
* All communication will be done through this email address.
Parent(s) or Guardian(s)
Phone
ACADEMIC STATUS
Check one
Incoming Freshman
Transfer Student
Current Student
Anticipated Major
Accounting
All Social Science Teacher Edu
Applied Behavior Analysis
Art
Biochem Molecular Biol
Biology
Business Admin.
Chemistry
Coaching K-12
Computer Science
Criminal Justice
Criminology
Criminology
Digital Communications
Digital Communications
Doctor of Physical Therapy
Economics
Educ of Amer Child
Education
Elementary Education
Endorsement
Endorsement(ELED)
Endorsement(SEED)
English
Environmental Science
Exercise Physiology
General Science Teacher Educ
Graphic Communications
Graphic Design
Graphic Design
Health Administration
Health Science
Health Science
History
History (do Not Use)
Human Performance
Human Resource Mgmt
Humanities
Humanities
INTERDISPPSYCBIOL
INTERDISPPSYCCJUS
IntdplSW,SOC, PS
IntdpmtlMCOMGDES
IntdsEduc, SW,PS
InterdiscPSYCSCED
InterdispHISTPHIL
InterdptELEDHPER
International Business
International Studies
K-12 Education
Leadership
Liberal Arts
MULTIPHBLCHEDSE
Management
Marketing
Mathematics
Mathematics Education
Medical Lab Science
Mgmt Info Systems
Mgmt Management
Multdes PS,SW,SOC
MultiSC,HS,PL,POL
Music
Music Education
Natural Science
New Media
Nursing
Nursing
Operations Management
Organizational Management
Organizational Management
Other Major
Peace Studies
Philosophy
Physics
Political Science
Pre Occ. Therapy
Pre-Dentistry
Pre-Engineering
Pre-Law
Pre-Medicine
Pre-Pharmacy
Pre-Physical Therapy
Pre-Physician Asst
Pre-Veterinary
Professional Studies
Psychology
Rad Technology
Respiratory Therapy
Secondary Education
Social Work
Sociology
Spanish
Special Education
Speech
Speech and Hearing
Sports Management
Sports Management
Sports Science
Theatre
Theology
Undecided
Writing
Academic status this upcoming academic year:
Freshman
Sophomore
Junior
Senior
Entrance Semester:
Fall Semester
Spring Semester
Year
2018 - 2019
2019 - 2020
Copyright 2012 by Briar Cliff University