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Student Housing Application

Step 1 of 5 - Personal Information

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Expected Move In: * Required
What semester do you plan to live on campus?
Personal Information
Name: * Required
First Middle Last Suffix
(If you don't have a middle name, enter "N/A")
Student ID: * Required

Your Student ID can be found on your acceptance letter.
Social Security Number:

Social Security Numbers are utilized for background check purposes only.

If you do not wish to include this information on the application, please contact the Housing Office at 269-294-4224.
Permanent Home Address: * Required
Street Address City State / Province / Region ZIP / Postal Code Country
Primary Telephone Number: * Required
Phone Type:
Secondary Phone Number:
Phone Type:
Email Address: * Required
Date of Birth: * Required
Gender: * Required
- Male
- Female
- Other
How did you hear about us?
- Friend
- School Visit
- Flyer
- Internet
- Local Ad
- Newspaper
- Radio
- Other
What is the best way to contact you so housing staff may have a conversation with you? * Required
- Phone
- Email
- Other
Other Way to Reach You: * Required
Best Phone Number to Reach You: * Required
Other Phone Number: * Required
Best Email Address to Reach You: * Required
Other Email Address: * Required
Academic Information
Are you currently an Early Middle College student?
- Yes
- No
High School or GED Granting Institution Attended: * Required
High School Graduation Date or date GED was conferred: * Required
Previous College Experience?
- Yes
- No
(Excluding courses taken while in high school)
GOCC Program of Study: * Required
Emergency Contact Information
Name: * Required
First Last
Primary Telephone Number: * Required
Phone Type: * Required
Secondary Telephone Number:
Phone Type:
Email Address:

Housing Unit Preference

The following information will be used in assigning the unit. All of the preferences and comments provided below will be considered; however, unit selection is solely based on availability at the discretion of the Student Housing Office.
If possible, I would like to be assigned to the following unit:
1st Choice:
2nd Choice:
Will you need a wheelchair accessible unit or other housing related accommodations?
- Yes
- No
Have you been convicted of a felony? * Required
- Yes
- No
Additional Comments:
Please provide any additional information or comments for consideration in regards to the unit assignment. (housing-related accommodations, allergies, preferences, etc.)

Roommate Information

Please list preferred roommates:
First Roomate Name:
First Last
Primary Telephone Number:
Phone Type:
Secondary Telephone Number:
Phone Type:
Email Address:
Second Roommate Name:
First Last
Primary Telephone Number:
Phone Type:
Secondary Telephone Number:
Phone Type:
Email Address:
Third Roommate Name:
First Name Last Name
Primary Telephone Number:
Phone Type:
Email Address:

Roommate Preferences

The following information will be used for roommate matching only. Please complete this section as if you were talking to a prospective roommate. Keep in mind that your honesty will benefit both you and your roommates. Check all items that apply.
Smoking
Do you smoke?
- Yes
- No
Would you live with someone who smokes?
- Yes
- No
Studying
How Much I Study:
- I study less than 1 hour/day
- I study 1-3 hours/day
- I study more than 3 hours/day
I like to study... (check all that apply)
- In my bedroom
- In the living room/kitchen
- At the library
- In the morning
- In the afternoon
- At night
Personal Habits
I keep my room...
- Neat
- Lived-in
- Messy
I anticipate having guests...
- Never
- Once a week
- 2-3 times a week
- 5 or more times a week
I consider myself to be a...
- Morning person (rise before 9:00 a.m.)
- Afternoon/evening person
- Late night person (up past 11:00 p.m.)
On most weeknights I...
- Watch TV
- Study
- Listen to Music
- Entertain Friends
- Go Out
- Work
On most weekends I...
- Watch TV
- Study
- Listen to Music
- Entertain Friends
- Go Out
- Work
Are you or will you be a GOCC athlete?
- Yes
- No
Of which athletic program are you/will you be a member?
Special Considerations:
Administrative Fee
How will you be paying your $75 non-refundable administrative fee? * Required
The Cashier's Office is located in Student Services.
You can pay in person with a credit card at the Cashier's Office, or you can pay by telephone. Paying your fee to Glen Oaks directly by credit card will incur an additional 2.75% transaction fee. In order to avoid this fee, you are encouraged to pay with a credit card via our PayPal option.

The Cashier's Office is located in Student Services or they can be reached by phone at: (269) 294-4235
Make checks payable to:

Glen Oaks Community College

If you are paying by check, please include the student's name and ID number on the check, or attach the check to documentation of the student's name and ID number.
Glen Oaks Community College
Attn: Cashier's Office
62249 Shimmel Rd.
Centreville, MI 49032
(269) 294-4235
To help us recognize your payment from PayPal, please indicate in the fields below the name of the person who will be paying the Administrative Fee as well as the name of the prospective housing resident.

Upon submission of this application, you will be directed to a page where you can complete your Administrative Fee transaction.
Required PayPal Information
Person Paying Fee: * Required
Prospective Housing Resident: * Required
Grant Permission to Share Information:
- I give permission to release my contact information and roommate matching preferences to prospective roommates.

Terms & Conditions
I understand acceptance of this application does not constitute a guarantee of housing, nor is it to be interpreted as academic admission to the College. A separate signed Student Housing Contract and non-refundable $75.00 administrative fee must be received by the Student Housing Office prior to assignment or move-in. An Application for Admission to the College must be received by the Admissions Office for consideration by Glen Oaks Community College. Only admitted students to GOCC are eligible to reside in student housing.

All eligible students must pass a background check to live in student housing. The cost of the background check is covered by the administrative fee.

All students must be in good standing with the College to be eligible to live in student housing (financially, academically and clear of conduct issues).

Eligibility Criteria for student housing:
- • Fully admitted and enrolled in 12 or more credit hours.
- • FAFSA submitted to Financial Aid Office with all required documentation on file.
- • Maintain a 2.0 grade point average.
Submit the $75.00 administrative fee to:

Glen Oaks Community College
Attn: Cashier's Office
62249 Shimmel Rd.
Centreville, MI 49032
(269) 294-4235
Release of Information for Criminal Background Check
All student housing applicants are required to have a background check performed before they can be approved for housing at Glen Oaks Community College (GOCC). The Housing Application becomes valid and the background check is performed when the complete application is submitted with the $75 non-refundable administrative fee. GOCC has partnered with Castle Branch to perform this service to the extent permitted by law.

I authorize the College and its agent, Castle Branch, to compile a report which may include information from a seven (7) year residency history, a County Criminal Search for both felonies and misdemeanors for all counties resided in, the National Criminal Database, and the National Sex Offender registry. I authorize custodians of the records of any agency or company as described above to release such information upon request of any agent of Castle Branch. I understand that any or all of these investigations or inquiries will be performed prior to my acceptance in student housing. I understand that the information requested is for the use by the College and may be re-disclosed only as authorized by law. I understand that I am authorizing GOCC to make inquiries into my personal history. I hereby release all involved in obtaining, providing, and/or utilizing any consumer reports or investigative consumer reports from any and all claims and damages of any kind whatsoever.
- By checking this box, I have read and agree to the terms outlined above. I understand that certain criminal history may disqualify me from on-campus housing at GOCC.
By checking the Electronic Signature box and clicking the Submit button below, I certify that I have read and agree to all terms and conditions set forth in this application. I understand this application is part of my housing agreement. * Required
- Electronic Signature

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Email: housing@svr1glenoaks.edu

Phone: 269-294-4224

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