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To complete the application, please fill out the form below and press the submit button. If you wish to clear the form and start over, press the clear button. The fields labeled in red are required, and the application will not be processed if they are empty. The application below is for the Academic Year 2014-2015 (Fall 2014 and Spring 2015).

Please use our Contact Us page at the top right if you are interested in just Spring 2015.

This page and all data you send through it is encrypted for your security.

Student Information

      

Last Name

      
   

First Name

      
    Middle Initial       
   

Social Security Number

      
   

Gender

      
   

Birthdate [mm/dd/yyyy]

      
      

High School

      
      

Major

      
       Study Habits        Morning Afternoon Evening
Late Night

       Hobbies/Activities        Sports Fitness Current Events
Music Socializing

      

How Did You Hear About Naismith?

 

 

      

if Current or Former Resident
please enter name:

Student Address

      

Home Street Address 1

      
      

Home Street Address 2

      
      

Home Street Address 3

      
      

City

      
      

State or Province

      
      

ZIP/Postal Code

      
      

Country

      
      

Home Phone Number

      
      

Cell Number

      

Parent / Emergency Information

      

Parent Last Name

      
      

Parent First Name

      
      

Parent Social Security Number

      
      

Parent Home Phone

      
      

Parent Emergency Phone

      
      

Parent Email Address

      
   

Emergency Relationship

      

Residential Data


  

Requested Room & Board Type (includes local sales taxes)

   

  

Alternate Room & Board Type (includes local sales taxes)

   

  When available: Parking Space Request ($300)
 

 

Mini Fridge / Microwave ($120)

      

University/College Attending

  
      

Year in College

      
      

Previous Housing

      
      

Student Email Address

      
      

Billing Email Address

      
      

UID Number (if unknown, leave "0")

  

Roommate/Suitemate Request

If you wish to be roommates or suitemates with certain people please indicate that in this section. Naismith Hall will only honor mutual roommate requests. The other person(s) with whom you would like to live must also request you as a roommate in his or her Room and Board Agreement Addendum. Room assignments are made on a first-come-first-served basis.

  Roommate Request  
       Suitemate 1 Request       
       Suitemate 2 Request       

Down Payment/Credit Card Information

Naismith Hall requires prospective residents to pay a $50 non-refundable processing fee.

      

Credit Card Type

      
      

Credit Card Number

      
      

Expiration Date [mm/yyyy]

      
      

CVN (What is this?)

      
      

Cardholder Name

      
      

Cardholder Address

      
      

Cardholder City

      
      

Cardholder State/Province

      
      

Cardholder ZIP/Postal Code

      
I hereby acknowledge that I have received, read, understand, and agree to the terms and conditions contained in the Naismith Hall Room and Board Agreement. I agree to be bound to the Room and Board Agreement terms and rates for the 2014/2015 Academic Year as indicated on the Room and Board Agreement Addendum. FOR VALUE RECEIVED, and in consideration for, and as inducement to The Bromley Group of Companies, Inc, as the AGENT for Naismith Hall, making the foregoing Agreement, the undersigned guarantees to the AGENT full payment and performance by the STUDENT of his or her obligations under the Agreement without requiring notice of non-payment, non-performance, or proof of notice or demand, all of which the undersigned expressly waives, and the undersigned expressly consents to any modifications of the Agreement, including but not limited to extensions of the term of the Agreement and adjustments to the room and board rates contained in the Agreement, and any extensions of time or indulgences granted by the AGENT to the STUDENT. I HAVE READ AND UNDERSTAND THE REFUND AND LIABILITY PROVISIONS CONTAINED IN THE AGREEMENT. I hereby authorize my electronic signature as submitted herewith to be as valid and binding as my original signature. Room and Rates Comparison.

Check this box to indicate your acceptance of the above statements.
Thank you for your interest in Naismith Hall at the University of Kansas. After you click on the submit button, your down payment will be processed and your completed application will be processed as soon as possible.

  
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