Enrollment Management
1000 West Austin, Nevada, Missouri 64772
Phone: (417) 667-8181
Fax: (417) 667-8103

Housing Assignment Application Form

* Required fields
Cell Phone:
Home Phone:

This application is to be filled out by the prospective student. Please respond to the following questions with care. Your answers will assist the College by indicating preferences to be considered for your room assignment. Complete honesty is essential to ensure that the best match possible can be made. We cannot guarantee perfect matches; however, an attempt will be made to arrange the best assignment considering the information provided. Please fill this form out completely.

For Questions 1 and 2: Cottey is a smoke and tobacco free campus. This includes e-cigarettes and other devices. The smoking information requested is to accommodate those who are sensitive to smoke odors.

1. Do you smoke? Yes No
2. Are you willing to live with a roommate who smokes? Yes No
3. I would be able to live in a room or suite with a
    service animal or an emotional support animal:
Yes No

4. In general, I:

follow a schedule and study/sleep at regular times.
do not follow any schedule or regular routine.
5. Do you anticipate:

going to bed early (before 11 p.m.)
staying up late (after 11 p.m.)
6. Do you snore?

I don't know
7. Do you require complete silence in order to sleep? Yes No
8. I feel most comfortable when my room is:

neat and everything put away.
clean but somewhat cluttered.
neat, but not perfect.
messy and not picked up regularly.
9. The kind of music I most enjoy listening to is: (Please check all that apply)
Adult Contemporary (Soft Rock)
Classic Rock
Hard Rock/Heavy Metal
New Age
Pop/Top 40

10. I would be particularly interested in rooming with a student from (please list a specific city,
     state, country, interest in rooming with an international student or no preference):

11. My birth order position in my family is: only child oldest middle youngest twin

12. What do you like to do in your leisure time?

13. Please indicate any health conditions that may require special accommodations or equipment. If you require
     special housing needs due to these conditions, please attach a brief statement of your needs to this
     application. (Please note: Requests received after June 1 may be unable to be filled)

14. Occasionally, a single room may be available to a first-year student. Singles are an additional $500
     per semester. Single rooms are assigned according to deposit date unless special needs are documented
     by the end of May.

     Are you interested in a single room (if available)? Yes No

15. Each hall has a quiet study room. In addition, three suites in each residence hall have been
     designated as quiet suites. Quiet suites are provided for those students who prefer a quieter
     environment in the suite area. Quiet suite policies and additional quiet hours are determined by the suite.

     Are you interested in living in a Quiet suite? Yes No

16. Robertson Hall is air-conditioned. The cost is an additional $175 per semester. All Robertson residents
     are charged this fee. Depending on space availability, some students may or may not be assigned to
     Robertson Hall, contrary to request.

     Are you interested in living in Robertson Hall? Yes No

17. Have you signed with (or have been offered
     a position on) a Cottey sports team?

Yes No

     If so, which team?

VB BB SB CC Golf Tennis

18. I would be particularly interested in being assigned to (you may list a specific hall or suite here)


19. My academic interest and/or potential career is:

20. Please share anything else that you feel should be considered in your housing assignment:

Important Of all the preferences you have listed previously (questions 1-20), please indicate the numbers of the three most important factors in your housing request.
Rank the question numbers in order of importance: 1) 2) 3)

The College reserves the right to require room changes a) when the living situation jeopardizes a student's academic and/or personal growth, b) to ensure maximum utilization of space and resources, or c) when chronic, disruptive behavior interferes with suite, academic, or personal life.

Cottey College does not discriminate in admission or access to, or treatment in, its programs and activities on the basis of race, color, national origin, religion, or disability. For further information, regarding student disability services contact the Office of Student Life at 417-667-8181 ext. 2157.

I, the undersigned, hereby acknowledge that the information contained in this form has been entered by me or under my direction.


© 2004- Cottey College   •   1000 West Austin, Nevada, Missouri 64772   •   Phone: 417-667-8181   •   Fax: 417-667-8103