OFFICE USE ONLY
Entered into CBORD___
Deposit posted ________
THE UNIVERSITY OF TEXAS AT EL PASO - MINER VILLAGE
STUDENT HOUSING APPLICATION
8/23/08 – 8/22/09
PART ONE: GENERAL INFORMATION (please print)
Name______________________________________________________________ Gender M / F UTEP ID__________________________
Family Name (Last)
First
MI
Mailing Address____________________________________________________________________________________________________
# and Street
City
State
Zip Code
Contact Phone Number__________________________________________
Contact email _____________________________
Have you ever been convicted of a felony or misdemeanor (excluding minor traffic offenses)? ___Yes ___No
if ‘Yes,’ list all offense(s) below. Please be aware that this information will only be used to determine your
eligibility to live in Miner Village Student Housing.
Felony/Misdemeanor
Date of Conviction
County/State of Conviction
__________________________________________ ____________________________ _______________________________________________
PLEASE MARK YOUR ROOM STYLE PREFERENCE IN NUMERICAL ORDER BELOW. NOTE: While every effort will be
made to accommodate your housing needs on a first-come, first-serve basis, keep in mind that not all room styles
may be available at the time of your application and non-refundable fee.
PREFERRED TYPE OF APARTMENT:
(Rates are good August 23, 2008 through August 24, 2009)
_______ TWO BEDROOM ($485 mo. per person)
_______ FOUR BEDROOM ($460 mo. per person)
_______ EFFICIENCY for two persons ( $355 mo. per person)
_______ EFFICIENCY for one person ($510 mo. per person)
Do you need ADA (American Disability Act)
accommodations? YES / NO
LENGTH OF CONTRACT REQUESTED:
______ 9 month (8/23/08 – 5/12/09)
______ OTHER (_______ - ________)
If you have a special circumstance which would
affect your length of stay (English Language Institute,
C.A.M.P., etc.) Please indicate here or attach an
explanation. NOTE: Priority will be given to applicants
requesting a 9 month contract in every case.
PART TWO: ROOMMATE PAIRING INFORMATION
It is our hope that your stay in Miner Village will be enjoyable as you pursue your educational goals. To help us before you arrive, please take a
few moments to answer the following questions honestly, and we will do our best to match you with a compatible roommate! When you receive
your room assignment, you will also be sent contact information for your new roommate(s), so that you may make plans before you arrive in the
fall. Remember: This part of “college life” may have you feeling intimidated, but it also has the potential to be a valuable “out-of-the-classroom”
learning experience.
Do you have a roommate chosen? Yes / No
If “yes” write their name here: ______________________ (this person must do the same on their application)
Your Age ______ (if under 21, date you will turn 21) _________________
Your City& State _____________________ (International students may list country) _____________
Are you a smoker? Yes / No
Are you a UTEP Scholarship Athlete? Yes / No
ROOMMATE SURVEY
Please give honest answers and circle the statement that best describes how you feel.
When it comes to keeping the room clean, you can count on me to:
a) clean up my messes immediately after I make them. I am a neat freak!
b) pitch in, especially if we could put together some type of schedule.
c) pick up after myself every once in a while, but don’t ask me twice!
As a general rule, the temperature in our apartment:
a) should respond to the temperature outside
b) will stay warm throughout the year. I get cold easily!
c) will stay cold throughout the year. I get warm easily!
d) will reflect the temperature outside. Let’s open those windows!
When guests visit my apartment this year:
a) I would welcome them to stay for a TV show, video game, or a meal only. No staying overnight!
b) I would only allow visitors when I am in the apartment as well.
c) I would not allow visitors in the apartment at any time.
d) I would have to discuss this with my roommate. I see all of these as potential options right now.
The best way to describe the refrigerator in my apartment is as follows:
a) all items are labeled and roommates need permission for use.
b) Items are purchased in bulk and are shared by everyone equally.
c) Not a lot of items. I don’t intend to cook much in my room.
d) Both (a) and (b)
Taking my class schedule, my work schedule, and my social life into consideration, the best way to describe my sleep schedule
will be:
a) I will have a regular sleep schedule, with an occasional late night.
b) I will have a unique sleep schedule, with..(circle two)
(very early mornings) (early mornings ) (late mornings) AND (early evenings) (late evenings) (late nights)
c) I can adjust to anyone’s schedule. This is not an issue for me.
My thoughts on “study times” are as follows:
a) Studying is important! I plan to block out times during the day and evening to study!
b) I’ll study some, but I also want time to be with friends and to enjoy “college life”.
c) I have little or no plans to study in my room this year.
PART THREE: SPECIAL INTEREST HOUSING OPTIONS
We would like to give you the opportunity to live on a floor with neighbors who have similar interests and motivations. To enhance
your living experience here at Miner Village, choose one of the options below. If you have no interest in participating in one of
these options, do not mark a preference; If you have more than one choice, rank them in numerical order.
_____ Academic Floors: While every resident should be concerned about their academic success at UTEP, we know that there
are students who require an intensive study-oriented environment.
_____ International Floors: Interested in living with someone from another country? Learn cultures, language and traditions from
your neighbors while sharing your own.
_____ Wellness Floors: If you are interested in meeting others who share your need for physical fitness, nutrition, and a commitment to
an alcohol/drug free lifestyle, this is your home.
_____ NEW IN 2008! Leadership on the Border-A Living/Learning Community at Miner Village: In the Fall of 2008, 26 first-year
students will live together in the same building, take classes together, explore the 2008 presidential campaign and it's impact on our border
community, as they explore their own potential for leadership on the UTEP campus. More information on this community can be found on
our website or by calling the Miner Village office.
ACKNOWLEDGEMENT OF APPLICATION
By signing below, I understand that my $200 reservation fee is non-refundable if I cancel this application.
I also understand that this is not a contract, but is an application to reserve a space in Miner Village. I further
understand that I will have a reservation fee posted to my UTEP account, which will be applied to my room
deposit upon my signature of the Housing Contract.
__________________________________ ____________
Student Signature
Date
_______________________________________ ______________
Guarantor’s Signature
Date
(Parent’s/Legal Guardian’s Signature)
THE UNIVERSITY OF TEXAS AT EL PASO does not discriminate on the basis of race, color, national origin, sex, religion,
or disability for employment or provision of services. This application is available in an alternate format upon request.