Residence Hall Information

Dorm Deposit Refund | Housing Reservation Renewal | Dormitory Room Reservation Application

DORMITORY ROOM RESERVATION APPLICATION

Name________________________________________ S.S.#_________________________ Date of Birth_____________

Home Address_________________________________________________________ Phone_________ Sex_______                                Street                                  City                                     State                  Zip

Name of Parent or Guardian___________________________________________________ Phone_________________

Address of Parent or Guardian_________________________________________________________________________                                                                  Street                                                     City                                                  State                      Zip

College Classification: ______Freshman _____Sophomore               Student Athlete: _____Yes  _____No

Ethnic Group: _____White   _____Black   _____American Indian    _____Hispanic   _____Oriental
(This question is optional, it is needed for federal statistics reports; therefore we would appreciate your response.)

Physical Handicap: _____No   _____Yes    If Yes, please explain if special arrangements need to be made.

Semester for which housing is desired: _____Sum I   _____Sum II    _____**Fall   _____Spring   _____Year

Meal plan desired: _____4-Day   _____5-Day   _____7-Day

**Students planning to live in residence hall for the Fall Semester must also pay a $200 prepayment by July 15.
This Prepayment will be deducted from the amount owed for room and board for the Fall semester. Please refer
to your catalog.

_____________________________________________________________________________________________

Angelina College accepts applications without regard to race, creed, sex, or religion.

A housing deposit of $100 must accompany this application. It is both a reservation deposit and a deposit
against damage, and must remain on file during a student’s use of housing facilities.

This deposit is refundable if:

1. Admission is denied

2. No housing is available, or

3. A written request is received with notice of cancellation in the Business Office on or before the following dates:

Not Returning for Cancellation Required By

Fall Semester           July 15

Spring Semester       December 1

Summer Semester    May 15

Room reservations must be confirmed by contacting the Business Office no later than the first day of registration.
Failure to confirm reservations will result in the room being made available to other students.

Enclose a check or money order payable to Angelina College and mail or bring it with this application to:                                  Angelina College, ATTN: Business Office, P.O. Box 1768, Lufkin, Texas 75902-1768

____________________________________________________________________________________________________________

I understand and accept the above requirements and agree to abide by the housing regulations
of Angelina College. I also understand that I, or my parent or guardian (if student is under 18 years old),
must sign a Housing Agreement Form.

________________________________________        ______________________________        ___________
Student’s Signature                          Date             Parent or Guardian Signature                 Date
                                                                             (If Student is under 18 years old)

OFFICE USE ONLY

Date Received___________ Receipt # ________________                                                          Revised 5/00