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  White, Non-Hispanic Black, Non-Hispanic Hispanic Asian or Pacific Islander American Indian/Alaskan Native Non-Resident Alien

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

Email Address  
(Failure to submit a valid email address may delay your application)

Permanent Address  

City     County/Parish 

State     Zip Code  

Major or Undecided  

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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:  None Band Choir Speech Drama Volleyball Womens Basketball Mens Basketball Baseball Rodeo Other

Please list some of your hobbies/interests:

Roommate Preference(s):
 

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

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.

I wish to live on campus during the following summer sessions:
Year  
May Intersession
Summer I
Summer II
 
Is this your first time in a Panola College Residence Hall?  Yes No

If you have not been living in a Panola College Residence Hall, 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 7:30a.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.

ROOMS WILL BE ASSIGNED ON A FIRST-COME FIRST-SERVE BASIS BASED ON THE DATE OF COMPLETED APPLICATION, DEPOSIT, AND PROOF OF INSURANCE/ MEDICAL WAIVER.

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.   No Yes

Current Students:  All you need to do to make a reservation for summer housing is complete this form.

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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.  

  No Yes

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 summer application.

  

Thank you!