Residence Hall Application Form | Manhattan Christian College

Name*

First Middle Last

Preferred Name

Gender*

Date of Birth*

Address*

Street Address City State ZIP Code

Primary Phone*

Email*

I plan to start MCC courses in the...*

Person to be notified in case of accident or illness.*

(Name, Relationship, Phone)

High School Graduation Date*

My current (or high school) GPA

(Approximate)

Incoming College Academic Classification*

Intended Program of Study*

The approximate population of my hometown/rural area

Hometown Church

Church Denomination*

Brefly describe your church involvement*

I would prefer a roommate who would keep the room neat and clean*

I like to stay up late at night (past midnight)*

I usually get up early in the morning (before 8:00 am)*

How do you consider yourself?*

List three hobbies you enjoy

Please list physical conditions which would require consideration

UntitledPlease give details of any physical, mental or emotional problem(s) you have had in the last five years

Please list any medications you are currently taking

If available, would you like to be in a quiet, study-intensive suite/floor?

Yes
No

Other specifics you would like us to consider in matching you with a roommate

Roommate Choice(s)

If you already have someone you would like to be your roommate, please list them here. Be sure to have the person you list also list you on their application.

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