Move In Registration Form

Basic information

UMID * Type only numbers, make sure your UMID is correct!

Email * Please enter your UM Flint email address

Phone number Enter you phone number with area code

International Student * NoYes

First Name *

Last name *

Address *

City *

State *

International State *

Country *

Zip *

Resident & emergency information

Room # *

Date of birth *

Emergency medical information

Please indicate any pertinent medical information: Prescription medication(s)AllergiesOther condition(s) e.g.: asthma, diabetes, epilepsy, etc.

Please specify prescription medication(s) *

Any significant allergies or details *

Any condition you would like us to know about * e.g.: asthma, diabetes, epilepsy, etc.

Can this information be disclosed to your RA? * YesNo

Emergency contacts

1st contact - Required

Name * Enter full name

Relationship to student *

Phone number *

Address *

2nd contact - Optional

Name Enter full name

Relationship to student

Phone number

Address

Security questions

For security purposes, please answer the following questions that ONLY you can answer. Do not share this information with anyone (including roommates), as these questions will assist us in identifying you in emergency situations

What is/was your pet's name? * If you don't have a pet, write "no pet"

What city were you born in? *

University of Michigan-Flint

Move In Registration Form

Housing and Residential Life