The Goodall Wooten
2112 Guadalupe • Austin, Texas78705-5516 512.485.7500 / Attach a 2”x 3”
photograph
APPLICATION FOR RESIDENCE
Long Term 20 ______- 20______Summer Sessions I______II______
PERSONAL INFORMATION
1.Full Name______
(Last)(First)(Middle)
Prefer to be called______Birthdate______Age______Sex: Male____Female______
Height______Weight______Eye Color______Hair Color______SS #______
Religious Affiliation______Nationality______Marital Status______
Austin Address (or mailing address if different from parents’ address below )
______Zip______Telephone #______
E-mail:______Cell phone # ______
2. Father’s Name______Telephone #______
Father’s Address______City______State____ Zip______
Father’s Occupation______Work Telephone #______
3. Mother’s Name______Telephone #______
Mother’s Address______City______State_____ Zip______
Mother’s Occupation______Work Telephone #______
ROOM INFORMATION
4. Although “THE WOO” is a non-smoking facility, do you smoke? Yes______No_____
5. Do you consider your study habits to be: Light______Medium______Heavy______
6. Would you describe your room as: Neat______Random______Messy______
7. Do you consider yourself: A Morning Person_____ A Night Person_____ Both______
8. Do you have any preference to room location? (not guaranteed)Intensive Study Floor_____ Other____
9. Room type desired: Suite____ Double____ Small Private______Private Suite______Large Private______
10. Would you like parking? (not guaranteed) Yes______No______
11. If you desire a particular roommate, please indicate name:______
12. List characteristics you think are especially desirable in a roommate: ______
______
13. List hobbies or other interests:______
______
14. How did you hear of THE GOODALL WOOTEN? (Please check all that apply)
Brochure____ Web Site_____UT Information_____ Personal Visit______Daily Texan______Friend______
EMERGENCY INFORMATION
15.In case of emergency, who should we notify?
Name______Relation ______
Address______City______State___Zip______
Daytime Telephone #______Work Telephone #______Nighttime Telephone______
16.Are you allergic to any drug? If so, which?______
Are you under medication for any medical problem? If so,what?______
ACADEMIC/EXTRACURRICULAR INFORMATION
17.Give the names of the high school you graduated from and also show other schools attended since:______
NameLocationGraduation DateG.P.A.
______
NameLocationGraduation DateG.P.A.
18.Please list the names of any friends or relatives who now live at the Goodall Wooten or have previously lived here:______
______
19.List Sororities / Fraternities and any other organizations of which you are or have been a member in high school or college. Please indicate any offices or honors held: ______
20.Please list the degree of your interest or participation in any sport.
SPORTYEARS of UIL/NCAA PLAY OFTENPLAY OCCASIONALLY
PARTICIPATION
______
______
______
21.What is your Academic Standing: freshman___ sophomore___ junior ___ senior ___graduate student ___?
22.What college of the university are you registered in? ______
23.Indicate your major field of study______
24.List any Academic Honors held.______
______
25.Please list two character references not related to you (including one teacher or principal)
I.______
NameOccupationYears Known
______
Address
II. ______
NameOccupationYears Known
______
Address
I pledge to abide by the regulations and standards of the University of Texas and the rules and regulations of the Goodall Wooten Dormitory.
Signed: ______Date: ______
To reserve a room,please mail your completed application along with your deposit* and application fee to:
Goodall Wooten 2112 Guadalupe,Austin, TX78705-5516
* We accept checks, money orders, traveler’s checks, & cashier’s checks drawn on a US bank