Panola College Residence Hall Application

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Residence Hall Application

First Name

Name I Go By (If different from First Name)

Middle Name

Last Name

Student ID
(for some students this will be their Social Security Number)

Date of Birth

Gender       M F Ethnic Origin

Home Phone No.
Cell Phone No.
                                 ex. 903-693-2000

Email Address
(Failure to submit a valid e-mail address may delay your application)

Permanent Address

City County/Parish

State Zip Code

Major or Undecided

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Residence Hall Request**

First Choice:

Second Choice:

Third Choice:

**We make every effort to place you in the residence hall you request: however, no rooms are guaranteed. Failure to select alternate second and/or third choices will indicate that you have no preference beyond your first choice.

Check here if you authorize the release of directory information such as your on-campus phone number and address.

Please answer the following questions as truthfully as possible.

Are you a Smoker Non-Smoker?

Do you like to stay up after 11 pm? Yes No

Do you like to get up early? Yes No

Do you like to have a quiet room? Yes No

Type of music you prefer is:
country pop classical/jazz R&B/rap Rock/Heavy Metal

You plan to participate in the following activities while living in the hall:
Athletics Drama Music Student Government
Religious Clubs Intramural Sports

I am on the following type of Scholarship:

Please list some of your hobbies/interests:

Roommate Preference(s)

Suitemate Preference(s)

Check here is you want your phone number released to your roommate so that they may contact you before school starts.

I wish to start living on campus:
Term Year

Is this your first time in a Panola College Residence Hall?

Students needing accommodations accessible by wheelchair, or students with other physical disabilities that require special accommodations, please check here and please email how we may accommodate you.

Completion of this form is the FIRST STEP to reserving a room at Panola College. You must complete the following steps, or a room WILL NOT be reserved for you.

1. A deposit of $200.00 is required to reserve a room. This deposit should be paid to the Business Office located in the Miller Administration building on the Panola College Campus in Carthage TX. Office hours are Monday-Thursday 7:30 a.m.-6:00 p.m. and Friday 7:30 a.m.-12:30 p.m. Summer office hours are Monday-Thursday 7:30 a.m.-5:00 p.m. and Friday 7:30 a.m.-12:30 p.m. If you wish to pay the deposit by phone, please call (903) 693-2000. Unless prior arrangements have been made with the Office of Residence Life, rooms will not be held beyond the first day of class. The deposit will be refunded in full (by check mailed to the address of record), provided no damage is done and the student does not have outstanding fines, after the student has officially checked out. Note: Failure to cancel a completed housing application in writing prior to 30 days before check-in day may result in the forfeiture of your deposit. Please see The Pathfinder pages 24-25 for additional housing contract information.

2. Applicants that have medical coverage should submit a copy of a current medical insurance card or provide the name of your carrier, policy number, and expiration date to the Office of Residence Life located in the Student Success Center in the Miller Administration building. Students choosing not to carry medical coverage must sign and return a medical waiver. A copy of this waiver may also be obtained from the Student Success Center.

3. You must register for classes for the upcoming full semester and provide the Residence Life Office with proof of registration--a copy of your account statement. Visit Campus Connect if you need to obtain a copy. Please contact the Student Success Center at (903) 693-2077 if you have any questions regarding verification of registration.

FAILURE TO PROVIDE VERIFICATION OF REGISTRATION WILL RESULT IN YOU NOT BEING ASSIGNED THE LIVING ARRANGEMENTS YOU REQUEST. ROOMS WILL BE ASSIGNED ON A FIRST-COME FIRST-SERVE BASIS BASED ON THE DATE OF COMPLETED APPLICATION, DEPOSIT, PROOF OF INSURANCE/MEDICAL WAIVER, AND RECEIPT OF VERIFICATION OF REGISTRATION.

I have read the above steps that are required to complete my application process and I understand that a room will not be reserved unless and until I complete all of the steps listed above.
I Understand How To Complete My Application

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I understand that I am responsible for all Panola College policies and rules as outlined in The Pathfinder and I agree to abide by these rules policies while I attend Panola College.

My typed name below affirms that the above information is true and correct.

Date
Signature

Click the Submit Form button ONCE to submit your Residence Hall application.

Thank you!

Resident Life Links:

For more information, contact
Office of Residence Life
903-693-2077
reslife@panola.edu

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Panola College is an Equal Opportunity Institution that provides educational and employment opportunities on the basis of merit and without discrimination because of race, color, religion, sex, age, national origin, veteran status or disability.

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