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Home
Rooms & Pricing
Amenities
Our Mission
Apply & Contact

Application

Please fill out the whole application (observing the various instructions). A member of our team will reach out to you to set up an in-person appointment soon after receiving your application. Thanks!

Be sure to read through the Housing Agreement first.

First Name*

Last Name*

Gender*

Male

Female

Email*

Phone Number (country code included)*

Birthdate (MM/DD/YYYY format)*

Address (city, state, and country included)*

Country of Citizenship*

Estimated Move-in Date (MM/DD/YYYY format)*

Rate Plan*

Full Year ($400/mo)

Academic Year ($450/mo)

Month-to-Month ($500/mo)

Emergency Contact Name*

Relationship to Applicant*

Emergency Contact Address (city, state, and country included)*

Emergency Contact Phone Number (country code included)*

Current Employer*

Employer Phone Number (country code included)

Employment Status

Do you have any allergies? If so, list below (write "N/A" if none)*

Do you have any physical limitations? If so, list below (write "N/A" if none)*

Do you take any current medications? If so, list below (write "N/A" if none)*

Do you have any learning disabilities? If so, list below (write "N/A" if none)*

Do you use any illegal drugs?*

Yes

Do you smoke or use tobacco?*

Yes

Do you drink alcoholic beverages?*

Yes

If you answered "Yes" to any of the preceding questions (drugs, smoking, alcohol), please explain:

Name of Home Church*

Church Address (city, state, and country included)*

How long have you attended this church?

How often do you attend?

List any ministries you have been involved with:

Explain your relationship to Jesus Christ:*

What do you love to do in your free time?*

What is your program/major at Washburn?*

How did you hear about Community Hall?*

I have read and understood the Housing Agreement*

Yes

Community Hall

Close to campus, designed for community.

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Visit Us

community-hall@communitytopeka.com

1520 SW 17th St. Topeka, KS 66604

CLOSE TO CAMPUS