Residence Hall Application

First Name is required
Last Name is required
Visit Campus Connect For Students (above). Student ID number will be in bold next to your name.
Cisco College Student ID is required
Email is required and must be in the format email@domain.com
Confirm Email is required and must be in the format email@domain.com
Address is required
City is required
State is required
Zip Code is required
Age is required
Birthdate is required
High School Attended is required
(ex. 2018-19, 2019-20)
Applying for Academic Year is required
(N/A if none)
Previous illnesses or injuries that a physician would need to know: is required
(N/A if none)
Current Medications: is required
(N/A if none)
Drug Allergies: is required
Emergency Contact (Name) is required
Emergency Contact (phone #) is required

Parent/Guardian Contact Information

Name is required
Relationship is required

Automobile Information

(A yes answer will not automatically disqualify you from on-campus living but, further explanation may be required.)

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Application Fee is not refundable. Grants, student loans, and scholarships may not be used to cover Application Fee.

Arrangements to pay for room and board must be made prior to registration.

If a residential student withdraws during the first 30 days of semester, room charges will be refunded on a pro rata basis.
(NO refund for housing charges after 30 days.)
Board charges will be refunded on a pro rata basis computed to the end of the week when the official withdrawal is completed.

If a student is removed from the hall for discipline reasons, NO refund will be made for housing charges.
Board charges will be refunded on a pro rata basis, computed to the end of the week when the official withdrawal is complete.

It is the policy of Cisco College to provide equal employment, admission, and educational
opportunities without regard to race, color, religion, national origin, sex, age, or disability.

Cisco College provides separate residence halls for men and women residents.
No married student housing is provided.

*All Cisco College students are required to posess, and have on their person, a current drivers license or state ID card.

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While a residential student at Cisco College, I agree to conduct myself in a manner acceptable in an
educational environment and polite society. I understand that the college has residence hall rules
and regulations. I agree to abide by the rules and regulations of the college as set forth in the
Residence Hall Handbook and Student Handbook. I understand that an infraction of the college
policy will result in an appropriate disciplinary action that may include the immediate eviction
from campus housing (without refund) and the refusal of future on-campus housing.

By signing this document, I affirm that I have read and understand the terms outlined in the Cisco College Residence Hall
Application and agree to abide by these terms.

If under eighteen years of age, parent or legal guardian must sign.
Signature is required
Today's Date
Date is required