Housing Application

Full Name:

First Name

Last Name

Birthdate:

MM/DD/YYYY

Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail:

email@somewhere.com

Cell Phone Number:

(XXX)XXX-XXXX

Father's Information:

First Name

Last Name

Home Phone

Work Phone

Mother's Information:

First Name

Last Name

Home Phone

Work Phone

Your email and or cell phone number will be used to notify you in events of emergency. If you wish to opt out, notify the housing office.

Application For School Year:

Semester:

Fall Spring Summer Session 1 Summer Session 2 Summer Session 3

Status:

New Student Returning Student Athlete - What Sport?

Classification:

Freshman Sophmore Junior Senior

Gender:

Male Female

Please give my address & phone number to my potential roommate.

Yes No.

The breakdown on the cost of student housing can be found in the "Bacone College Catalog" under Financial Information at www.bacone.edu. In signing this form, I am stating that I have filled out the above information accurately and truthfully. I understand that Bacone College and its facilities are alcohol, drug and tobacco free. I also understand that if I complete the exemption form and if it is denied, I will be enrolled automatically into student housing and assigned a room.

Signature:

Signature

MM/DD/YYYY

An exception to the housing policy may be granted if you meet the criteria. All applications for exemption must be presented to and approved by the Director of Housing and Hospitality. Proof of marriage, birth certificate of child, custody documents for a child, driver's license or utility bill will be requested to show just cause for an exemption to be approved. All exemption applications will be answered within 48 hours of receipt by the Housing Office. You may request an exemption form from the Housing Customer Service staff.