2016 Summer Student Housing Application
Returning to UCA Housing for the Fall 2016 semester?
yes
no
DEMOGRAPHIC DATA:
Name:
B
UCA ID #:
Last
First
Middle
Email Address:
Birth Date:
Primary Phone: (
Age:
)
Gender:
University Athlete? Yes No
Academic Classification (fresh, soph, JR, SR):
Have you ever been convicted of a felony (circle)?
Yes
No
What Sport?
If yes, attach written explanation.
The University reserves the right to deny housing to any student consistent with the goals and objectives as outlined in the Housing & Residence Life Mission
Statement.
SUMMER HOUSING REQUEST
Check all that apply (summer housing charges are not prorated):
Rates:
May Intercession- May 1 - May 27 (only available to current Spring 2016 residents )
$350.00
Summer I - May 29 - July 1
$434.00
Summer II - July 3 - August 5
$434.00
August Intercession - August 6 - August 13 (only available to Summer II residents returning for Fall 2016 )
$100.00
**Summer placement is determined by your fall assignment based on availability. The designated summer halls are Hughes
Hall and New Hall. Single rooms, when available, are $599.00 per term.**
Optional Meal Plans:
50 Block + $100 DD- $455
75 Block- $505
$400 DD- $400
*Consider adding BearBucks for the summer! They do
not expire and are accepted off campus. Check out
uca.edu/bearcard/bearbucks for more information.
Office Use Only
Group:
Spring 2016:
Fall 2016:
Classes:
Summer:
ROOMMATE/SUITEMATE PREFERENCES:
1. Roommate:
2. Suitemate:
3. Suitemate:
UCA ID #: B
UCA ID #: B
UCA ID #: B
ROOM ASSIGNMENTS:
Assignments are made without regard to race, creed or national origin. The University considers employees and students on the basis of individual merit
without regard to gender, race, religion, national origin, age, disability, or other factors irrelevant to participation in its programs. Room assignments are
made on a first-come, first-served basis. A student will be considered assignable once the summer application is received in the Housing Office. Once
assigned, you can view your Housing details online on myUCA.
READ THE APPLICATION CAREFULLY AND SIGN:
I understand that acceptance of this application does not constitute a guarantee of assignment to university housing or admission to the University. I
understand I must cancel BEFORE the beginning of the summer term to avoid charges. Summer Housing term charges are NOT prorated. I have read and
understand the information on the back page and the terms of this application stated herein.
Student Signature:
Phone: 501.450.3132
Date:
University of Central Arkansas
Department of Housing & Residence Life
201 Donaghey Avenue, Bernard Hall Suite 201
Conway, Arkansas 72035
Email: [email protected]
Web: uca.edu/housing
Revised 02.16.16 SM
Fax: 501.450.5374