Online Form





BlueStripe Housing Registration Florence Fall 2019

First name Last name
Address 1
Address 2
City State /Province
Zip Code /Postal Code Country
Male
Female
Through my home university
Through the university/school/institution I'll be attending
Through a friend
Web search
FUSAC
Other
Shared Room
Single Room

Full-Year Payment
Full-Semester Payment
Payment In 3 Installments

Yes
No

Please provide the name of the person or institution responsible for payment
Please provide the email of the person or institution responsible for payment
Please describe your relationship with the person or institution responsible for payment
I am paying for myself
Parent
Other Family
Significant Other
University
Employer
Military
Other

In case of emergency, who should we contact?
Please describe your emergency contact’s relationship to you
Legal guardian
Parent
Significant Other
Other family member
University
Other