Housing Application

It is recommended that you print this form in order to keep a copy for your files.
You can also download the Printable Version and send it in via fax or regular mail.

Southern Arkansas University Tech
P.O. Box 3499
Camden, AR 71711
Voice: (870) 574-4519
Fax: (870) 574-4460

Instructions - Complete all fields below. Use the Tab key on your keyboard to move between fields. If some of the fields do not apply to you, do not enter any data.

Personal Information
Social Security Number: *

(Example Format: 123-45-6789)

First Name: *
Middle Name:
Last Name: *

Physical Address: *
Mailing Address:

If same as Physical Address, leave blank

City: *
Zip Code: *

County/Parish: *

Phone Number: *

(Example: 918-555-1234)
1st Alternate Number:

(Example: 918-555-1234)
2nd Alternate Number:

(Example: 918-555-1234)

E-mail Address:
Age: *
Date of Birth: *

Gender: *

Race: (Optional)
Check all that apply

(This information will be used in a nondiscriminatory manner consistent
with civil rights laws & is used for federal/state reporting only)

Drivers License #:
Semester Applying For: *

Roommate Information/Request
Roomate Name:
Roomate Hometown:

Do you plan to bring a vehicle: *

List, in order, your preference for housing, with the first being your top choice.
Preference #1: *
Preference #2:
Preference #3:

In addition to the Housing costs for the semester, there is a one-time refundable application/damage fee of $100.

*On-campus housing is the only option available for summer residents, unless overflow housing is necessary. Prices subject to change.

Describes Me:

Important to me in a roommate:

Disciplinary Information
Have you ever been convicted, pleaded guilty, pleaded no contest, or are you presently charged by indictment or information with a crime (a felony) which might be punishable by incarceration? *

All applicants are subject to a criminal background check. By submitting this application, you authorize SAU Tech to conduct a background check and affirm that all information you have provided is true and accurate to the best of your knowledge. Any misrepresentation of facts could be cause for refusal or eviction from housing.

When you have completed the Online Housing Application, click the "Submit" button only one time.

Note: If you have a physical disability, the Housing Office must be notified 10 days before the Fall or Spring semester begins.
SAU Tech housing is a drug-free, alcohol-free, smoke-free environment.
Please send comments to Student Life