Residence Life Program

Last Name :
First Name :
Address :
City :
State :
Zip :
Country :
Phone Number :
Email :

Is your internet connection (check all that apply):	Broadband	Dial-up	DSL

Check when you plan to live On Campus and select the year	Fall/Spring	Spring	Summer
	2010-2011	2010	2010
	Other	2011	2011
		Other	Other


If you are having technical difficulties with the completion of form please email your request to alrau@csufresno.edu