Helena College Housing Request Form

This housing request is intended for:

First Name

Last Name

Age

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone

Total number in household (yourself + spouse and/or dependents requesting to live on campus)

I prefer to live

alone

with a roommate

Would you like Carroll to select a roommate for you?

yes

Move in Start Date

Move in End Date

Additional Information