Academic Class Status:   SO   JR   SR         APT #:
Please select your Academic Class Status.

Property:     1030 W. Wood St       1035 W. Wood St
Please select your Property.

Length of Lease:   Fall Spring  Summer Fall Spring  Summer  Fall Only  Spring Only 
Please select your Length of Lease.

Submit copy of MILLIKIN ID or DRIVERS LICENSE or STATE ID CARD

Name:    MU ID #:

Permanent Address:

City:       State:       Zip:

Cell Phone #:                     Birthdate:

DL #:                     SS #:

Parent/Guardian Name:

Home Phone #:

Parents Email:

Will you be receiving Financial Aid?     YES     NO

Will you need parking?     YES     NO

Are you a member of a Millikin sports team?     YES     NO    

Are you a member of fraternity/sorority?     YES     NO             

By signing this agreement, I authorize Millikin University to release information to The Woods at Millikin concerning my financial, academic
and/or personal information for the upcoming year.

Signature/Name:    Date: