Residency Information Form

The form must be complete by all students enrolled in on-campus programs at Kentucky Wesleyan College. Please complete this form as soon as possible.

Deposit Confirmation*

I have made my enrollment deposit to Kentucky Wesleyan College

Please note, you must make your enrollment deposit to Kentucky Wesleyan College prior to submitting this form.

Personal Information

First Name

Middle Name

Last Name

Home/Permanent Address

Country

Street

City

Region

Postal Code

Personal Email Address (non-school):

Mobile Phone Number

Birthdate

Gender

Female

Male

Non-Binary

Are you married?

Yes

No

Prefer not to answer

Emergency Contact

All students are required to provide an Emergency Contact to be used in the event you have an emergency situation while on campus or at a College sponsored event.

Do you have an emergency contact?

Yes

No

Relationship

Contact First Name

Contact Last Name

Contact Phone Number

Additional Information

What is your intended major?

Are you participating in an athletic team? If so, which sport?

What is your enrollment status?

When do you plan to enroll?

Please let us know if you will be living:

On Campus

Off Campus, Living at Home

Off Campus, Not Living at Home

Online

Residential Student Questionnaire

Your new home at Kentucky Wesleyan College will be friendly and inviting, and we want to ensure compatibility between you and your new roommate. To help make the best possible housing assignment for you, the Student Services needs the following information.

I request my roommate to be:

Tell us about the hours you keep:

I tend to be a night owl (stay up late, get up late).

I tend to be an early bird (go to bed early, get up early).

Tell us about how you like to sleep:

I like to sleep with music or the television on.

I like to sleep in silence.

Tell us how you like to study:

I prefer to study in a quiet room.

I prefer to study with music or the television on.

Tell us which statement you agree with:

I prefer to keep my room cooler.

I prefer to keep my room warmer.

Tell us about your study habits:

I tend to get ahead of my work

I tend to cram the night before an exam.

Check the box if you agree with the options below:

I believe roommates should be able to borrow items when needed (clothes, food, movies, etc.)

I am good at remembering messages and passing them along to others

I am often forgetful and do not remember messages.

I keep a clean room.

I am more likely to talk about problems with my roommate to work them out.

I am more likely to keep problems with my roommate to myself.

If possible, I would like to room with someone with the following interests:

I understand that I am providing my housing preference and that my room assignment will be made based on date of deposit and completion of my Housing Application. Providing my preference does not guarantee my housing assignment. I understand that breaking my housing could lead to a $1000 fine. I understand it is my responsibility to find my own renters insurance.

I have read the above disclaimer.

Special Needs

Do you have any dietary restrictions/needs? Please explain:

If you have a chronic condition or physical limitation that warrants special housing considerations, please attach a physician's letter to this form indicating the type of accomodations needed.

Attach physician letter:

I acknowledge by clicking submit, I give Kentucky Wesleyan College permission to contact me using the included contact information including emails, calls and/or text messaging.