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Housing Application

Housing Application

Full Name * Required
First Name Middle Name Last Name
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
County * Required
Cell Number * Required
Email * Required
T-Wolves Email (If Known)

A receipt will be sent to your T-Wolves e-mail address you provide
Date of Birth
MM slash DD slash YYYY

Date
Emergency Contact
Emergency Contact Name * Required
First Name Last Name
Daytime Phone * Required
Evening Phone * Required
Academic Information
Student Type * Required
Select Term
Roommate Matching Information
Gender * Required
Parking space needed? * Required
- Yes
- No
Disabled/Medical Accessibility: * Required
- Yes
- No
Dismissed from another college? * Required
- Yes
- No
Roommate Request
Roommate Name 1
First Name Last Name
Roommate Name 2
First Name Last Name
Roommate Name 3
First Name Last Name
Listed roommates must request and agree to assignment.
Consent * Required
Students residing at Student Housing Village at NCCC are expected to conduct themselves in a manner appropriate to an academic community living environment. I warrant that all statements above set forth, to the best of my knowledge are true and correct. I understand that deliberately submitting false information or withholding information constitutes fraud. Federal law specifies fines up to $10,000 and prison terms up to five years for fraud and may be grounds for eviction.

I also understand that this form is only an application for residency and that the submission of this application does not reserve nor in any way guarantee an apartment or bedroom. Room assignments will be given on a first come, first serve basis according to the date on which the Office of Residence Life receives a completed Student Housing Licensing Occupancy Agreement from the student.

Deposits are non-refundable 60 days within the start of the next semester.
I agree.

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