Housing Application Form

In order for your preference to be considered, this form must be submitted by:

June 1 for the fall term
December 1 for the spring term

Personal Information

First Name: *

Last Name: *

Email Address: *

Birthdate: *

Gender: *

Male

Female

During Academic Year: *

I will attend: *

Full Year

Fall Semester

Extended Fall Semester

Spring Semester

Housing Agreement

I have read the AJY housing policies and the description of housing in Heidelberg in the AJY Pre-Departure Handbook and would like to indicate that:

I am in agreement with those policies and request that the AJY program secure me housing. I hereby give my permission for the AJY program to make an application on my behalf to the University's housing office.

Room Preference

The program secures each student a room and expects that you will accept your room assignment. You may have to accept a housing arrangement different from what you desire, but please be assured that final assignments will be made in the fairest manner possible. For further information, see “Housing” in the AJY Pre-Departure Handbook.

Please select a 1, 2, or 3 to rank your first, second and third choices for housing

Single room in a dormitory with shared bath and kitchen facilities for approximately 16 students per floor:

Single room in a privately-owned dorm with 25-30 other students:

Single room in a small dormitory for female students only:

Single room with kitchenette and bath (efficiency apartment) in a university dormitory:

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Contact Information
Heidelberg University
310 E. Market St.
Tiffin, Ohio 44883-2462

Phone: 419-448-2062
Fax: 419-448-2217

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Housing Application Form