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Please complete the form below to request housing with a current EVMS student the night before your interview.

1) Name

(Question Mandatory)

2) E-Mail Address

(Question Mandatory)

3) Phone w/ Area Code

(Question Mandatory)

4) Gender

(Question Mandatory)
Male
Female

5) Interview Date

(Question Mandatory)

6) Do you mind staying with a host of the opposite sex?

Yes
No

7) Do you smoke?

Yes
No
N/A

8) Do you have any allergies? If yes, what type, i.e., dogs, cats, etc.


9) When will you be arriving (date/time)?


10) Comments