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ANGELINA COLLEGE RESIDENCE APPLICATION
Currently, our dorm hall is filled. There are no vacancies at this time. However, if you have been instructed to fill out this form because you are a student athlete at Angelina College, please continue to fill this form out. Our residence hall no longer has room for any general population students.
Email address *
Last Name *
Your answer
First Name *
Your answer
Middle *
Your answer
Social Security No. *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Email *
Your answer
Date of Birth *
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Gender *
Year Applying *
Your answer
Semester *
Required
Classification *
Required
Were you recruited (or signed a letter of intent) by one of the following organizations? *
Required
Do you have a chronic or physical disability that requires special arrangements? If yes, please explain: *
Your answer
Parent or guardian contact info *
Your answer
Relationship *
Your answer
Home Phone *
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
Previous illnesses or injuries that an emergency physician would need to know *
Your answer
Current medications *
Your answer
Drug allergies *
Your answer
Automobile's Year, Make, Model, Color, License Plate (required): *
Your answer
Major *
Your answer
High School *
Your answer
Roommate requested *
Your answer
Please click this link to fill out the Missing Student Contact Registration Form then check the box to indicate you have filled it out: https://goo.gl/forms/tKXPAKy7SnOmZdKr2 *
Required
Important Notice:
Arrangements to pay for room and board must be made prior to registration. All students living in the AC residence hall must enroll in 12 semester credit hours (sch). If a residence student drops below 12 sch you will be asked to vacate the residence hall.
If withdrawal occurs during a semester, no refund will be made for room rent after 30 days. However, the board charge will be refunded on a pro rata basis computed to the end of the week when the official withdrawal is completed.
Have you ever been convicted of a violation of any local, state, or federal law, other than minor traffic violations (including a plea of guilty or no contest)? *
Required
Are you currently under probation for a violation of any local, state or federal law? *
Required
I understand by signing this residence hall application, I give Angelina College consent to perform a background check.
PLEASE READ THE FOLLOWING PRIOR TO SIGNING BELOW:
While a resident student at Angelina College. I agree to conduct myself in a manner acceptable in an educational environment and civil society. I understand that the college has rules and regulations. I agree to abide by the rules and regulations of the college as set forth in the General Catalog and Angelina College Policy and Procedures manual. I understand that a violation of the college policy will result disciplinary action in accordance with the Angelina College policy and my include immediate eviction from the residence hall. I agree to fill-out and submit the MISSING STUDENT CONTACT REGISTRATION FORM. https://goo.gl/forms/XhQt6Ll36NaNjxO32
Student Signature
Your answer
Date
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Parent or Legal Guardian (students under 18 only)
Your answer
Date
MM
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DD
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YYYY
CHECKLIST OF ITEMS TO MAIL AC HOUSING OFFICE
A room will not be reserved with the following: This application, filled out completely; $100 Deposit, Make check or money order payable to Angelina College, NO CASH. Financial aid may NOT be used for the deposit.
Mail to:
Angelina College
Attn: Housing
PO Box 1768
Lufkin, TX 75902
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