Housing Request Form

Student

First name

Middle name

Last name

Mailing address

Country

Street

City

Region

Postal Code

Email address

Birthdate

Living Arrangements

To learn more, please visit the Residency Policy.

I will be enrolling

Spring 2025

Fall 2025

Please select the student type that best describes you:

First Year

Transfer

A first-year student has not previously attended a college or university and wishes to complete a traditional, full-time undergraduate degree program during the day. (Students may have earned credits from a dual-credit program or community college while concurrently enrolled in high school.)

A transfer student previously attended a college and wishes to complete a traditional, full-time degree program during the day.

I will

Live on campus

Live off campus

Live off campus

Live at home (You must live with a parent/guardian within 30 miles of campus and have an approved Commuter Certification form on file with the Residential Education Office.)

Live off campus because I will have turned 21 by the start of the academic year

Live off campus (not with a legal guardian) because I am married

Live off campus (not with a legal guardian) because I have a dependent child

Live off campus (not with a legal guardian) because I am an Active Duty service member

If you feel like your current situation does not fit any of the categories listed, please contact the Residential Education Office.

Housing Preferences

Room assignment is based on the date your admission deposit is received. While we make every effort to honor your requests, housing preferences are not guaranteed. You may be assigned to any of these facilities and/or room types. Residential Education will use a student’s self-defined gender when making housing placements.

Please note that while we will continue to honor housing location preferences as much as possible, opting in to a gender-open community and/or being approved for an ESA may take precedence in where we can best place you.

Sex assigned at birth

Female

Male

Pronouns

If you identify differently from your birth-assigned gender, or if you would like to share more about your gender identity, please share here (Optional)

I would prefer a

Double Room

Single Room

The type of room (double/single) does not matter to me

Gender-Open Housing
Residential Education provides “gender-open housing” meaning that two or more students may mutually agree to share a multiple-occupancy residence hall room, suite, apartment or townhouse unit, regardless of a student’s sex or gender. The purpose of this policy is to provide students an increased choice in selecting roommates based on whom they feel the most comfortable and safe with, regardless of gender, to support their various living needs. This gender-open housing policy supports the university’s non-discrimination policy with respect to gender, sexual orientation, gender identity, and gender expression. To learn more about this policy, please visit the gender open housing policy.

Please note that within a gender-open community, some parts of the hall may have mixed-gendered rooms among traditionally-gendered and gender-open rooms. In traditional-gender communities, neighboring rooms will all be traditionally-gendered (students of the same gender in a living space).

Only students who explicitly indicate on this form and via additional communication will be placed into a gender-open living arrangement.

Please indicate your interest in living in a gender-open room/community below. Residential Education will personally contact all students who indicate interest via the provided phone number or email address to discuss their individual needs.

Gender-open room/community

I am interested in a gender-open room and you can contact me at the phone number or email provided above.

I am interested in living in a gender-open community (the room next to me might not be a traditionally-gendered room) and you can contact me at the phone number or email provided above.

I am not interested in a gender-open housing option or community.

Community Preference (please rank your top three choices):
Room assignment is based on the date your admission deposit is received. We make every effort to honor your requests, however, housing preferences are not guaranteed. You may be assigned to any of these facilities. You can view the price of each facility here.

Choice 1

Choice 2

Choice 3

Community Preference (please rank your top three choices):
Room assignment is based on the date your admission deposit is received. We make every effort to honor your requests, however, housing preferences are not guaranteed. You may be assigned to any of these facilities. You can view the price of each facility here.

Choice 1

Choice 2

Choice 3

Centennial

Doubles $3,337

Singles $3,646

Johnson $3,654

Pioneer $3,654

Plainsman $3,337

Community Preference (please rank your top three choices):
Room assignment is based on the date your admission deposit is received. We make every effort to honor your requests, however, housing preferences are not guaranteed. You may be assigned to any of these facilities. You can view the price of each facility here.

Choice 1

Choice 2

Choice 3

Community Preference (please rank your top three choices):
Room assignment is based on the date your admission deposit is received. We make every effort to honor your requests, however, housing preferences are not guaranteed. You may be assigned to any of these facilities. You can view the price of each facility here.

Choice 1

Choice 2

Choice 3

I typically keep my living space

Clean and organized

Not organized/OK with clutter

I’m somewhere in between these options

I prefer to live with someone who is clean and organized

Yes

No

Doesn’t matter to me

I consider myself

An early riser

A night owl

Could you live with someone who considers themselves a night owl?

Yes

No

Doesn’t matter to me

I hope that my room primarily will be

A quiet place to study

A gathering place for friends

I am a smoker

Yes

No

All residential facilities at Nebraska Wesleyan are smoke-free. Could you live with someone who chooses to smoke elsewhere?

Yes

No

I would like the opportunity to live with an international student in Centennial Hall

Yes

No

Tell us about the type of interests or qualities you are hoping your roommate to have.

What would you like your roommate to know about you?

Admissions Show Room
NWU provides prospective students and their guests the opportunity to see residence hall rooms as part of their campus visit. Residence hall “showrooms” are displayed for a few minutes during the campus tour. Tour groups may visit showrooms anytime between 9 a.m. to 4 p.m. Monday through Friday. Students whose rooms are selected as showrooms are credited $200 towards their tuition at the end of the academic year.

Would you be willing to live in a room designated as a showroom?

Yes

No

Living with an Emotional Support Animal
Some of our residents have been approved by our Coordinator of Services for Students with Disabilities to have an Emotional Support Animal (ESA) live within their residence hall room. While the type of approved animal can vary, the most common ESA in our buildings are cats. Please indicate your willingness to live with a student that has an approved ESA below:

Emotional support animal

Yes, I would be interested in living with a roommate who has an approved emotional support animal.

No, I would not be interested in living with a roommate who has an approved emotional support animal.

Please indicate if you have any animal-related allergies that significantly impact your living environment. (Optional)

Roommate Request
To request a roommate, list your roommate preference below. Your roommate must also list your name on their housing preference form. All roommate requests MUST be submitted by June 15 for fall placements (January 1 for spring placements) and via a housing request form (not to an admissions counselor, coach or over the phone to the Residential Education office) to be considered. Roommate requests take priority over building preference.

Roommate’s name (Optional)

Americans with Disabilities Act
If you have a medical condition (physical and/or mental) that may require a housing accommodation, please contact Michael Cruce, Director of Student Accessibility, at mcruce@nebrwesleyan.edu prior to June 1 for initial consideration in fall housing placement (December 15 for spring placement).

Please select this box if you plan to apply for a housing accommodation

Updating Your Housing Information
At any point before housing placement you need to update or change this information (such as changing or adding a roommate’s name), please submit a new Housing Request Form. We will use the most recent form when placing students.

I understand that I need to submit a new Housing Request Form each time I need to update or change my housing information before January 1.

I understand that I need to submit a new Housing Request Form each time I need to update or change my housing information before June 15.