Housing Request Form – Brescia University Students

Please complete the form to request housing at Brescia University.

Name*
First Last
Gender*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Check in Date*
Please note that you will need to provide your own XL Twin Sheets, towels, toilet paper, toiletries etc. as these are not provided by Brescia University.
Check out Date

ex. December 12, 2016
Names of Desired Roommates*

List up to 4 individuals of the same gender.
Will you require a handicap accessible room?*

Limited number available.
Please mark all dates that you will want breakfast (additional cost).
- Friday, June 23rd
- Saturday, June 24th
- Sunday, June 25th
Room cost is $35 per person per night for a single dorm room or $45 per person per night for an apartment style room (5 bedrooms) and can be paid online at https://www.brescia.edu/pay and choosing the space rental option or by mailing a check to: Attn: Isaac Duncan, Brescia University, 717 Frederica Street, Owensboro, KY 42301.