SUNY Niagara Housing Application

"*" indicates required fields

Full Name*

First Name Middle Name Last Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County*

Cell Number*

Email*

T-Wolves Email (If Known)

A receipt will be sent to your T-Wolves e-mail address you provide

Date of Birth*

Date

Emergency Contact Name*

First Name Last Name

Daytime Phone*

Evening Phone*

Student Type*

Select Term

Gender*

Parking space needed?*

Yes

Disabled/Medical Accessibility:*

Yes

Dismissed from another college?*

Yes

Roommate Name 1

First Name Last Name

Roommate Name 2

First Name Last Name

Roommate Name 3

First Name Last Name

Listed roommates must request and agree to assignment.

Application Fee & Security Deposit*

Price:

Payment Method*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name