La Jolla
BYU-Idaho Approved Housing for Young Women
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If you have questions or comments please call us at (208)359-1985.

Application Form
First Name:
Last Name:
Current Mailing Address:
Mailing City:
Mailing State/Province
Mailing Zip/Postal:
Birthdate:
Hobbies & Interest:


Guardian Information
Guardian First Name:
Guardian Last Name:
Guardian Address:
Guardian City:
Guardian State/Province
Guardian Zip/Postal:
Parent/Guardian Home Phone:  
Semester(s) Applying for:
Semester Year
Contact Information
Your Email:
Your Mobile Phone:  
Your Work Phone:  
Best Time to reach you:

Other Information
Year in School:
Do you plan on bringing a car:
    If Yes, provide License Plate #,
    Make, Model, and color of car:
Floor Preference:
Roommate Requests:
Apartment Request:
Where did you learn about La Jolla:
    If Other, Where?
Other Comments:




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75 S 1st W  |  Rexburg ID 83440  |  208.359.1985  |  Rexburg Web Design