Off-Campus Housing Application Rockland Community College
Please complete this application to apply for off-campus housing at Nyack College. If you are under 18, you will be required to provide a parent/guardian signature in order to accept the housing if you are selected.
Student Name *
Your answer
Student ID Number *
Your answer
Academic Status *
Permanent Mailing Address *
Your answer
Gender *
RCC Email Address
Your answer
Personal Email Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Contact Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Race/Ethnic Origin
Select one or more
If Hispanic/Latino, is your background
Residency Status *
Do you have any prior felony convictions? *
Have you applied for Financial Aid? *
Please type your full name below to acknowledge that the information submitted is true, correct and complete. *
Your answer
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