OFFICE OF STUDENT HOUSING / ONLINE APPLICATION
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NOTE: This application is to be completed by all students who desire residence life while attending Talladega College. Students who reside on campus are required to pay a non-refundable room fee of $200. A money order or cashier’s check made payable to Talladega College Office of Residential Life must be mailed or paid by July 1, 2012. Your application will not be processed until the non-refundable housing fee has been received.
NO CASH OR PERSONAL CHECKS WILL BE ACCEPTED
Students who reside on campus are required to have a post office box and a meal plan.
PAYMENTS SHOULD BE MAILED TO:
Office of Residential Life
Talladega College
627 West Battle Street
Talladega, Alabama 35160
Term(s) of Application
-- Please Select --
Spring 2012
Fall 2012
Spring 2013
Fall 2013
First Name
Middle Name
Last Name
Gender:
-- Please Select --
Male
Female
Date of Birth
Street Address
City
State:
-- Please Select --
-- Select State --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
(please include post office box number if applicable)
County
Country
Phone
Email
Address
Marital Status:
-- Please Select --
Married
Not Married
Roommate Preference: We do not guarantee roommate preferences or compatibilities.
Name of Requested Roommate
(Preference 1)
Name of Requested Roommate
(Preference 2)
NOTE: When a specific roommate is requested, the request must be mutual, and priority is given to the
request on the receipt of deposits for each room resident.
I, , give the Office of Residential Life at Talladega College permission to release the following information, name and telephone number to my perspective roommate. I understand that Residential Life assumes no liability for honoring my request. I further understand that acceptance of this application does not constitute or guarantee a residence hall room or admission to Talladega College.
Parent(s) Signature)
Date
(Required for students under the age of 18
Your Classification:
-- Please Select --
Freshman
Transfer
Re-admit Student
Returning Student
Do you require health accommodations?
-- Please Select --
Yes
No
(Please specify)
Who should we contact in case of an emergency?
Relationship to you?
Home Telephone No.
Address
City
State:
-- Please Select --
-- Select State --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Insurance
We highly recommend students to purchase fire and theft insurance for the term of this application. The Office of Residential Life will provide information regarding fire and theft insurance per the student’s request.
*RESIDENTS ARE ENCOURAGED TO CARRY SOME FORM OF PERSONAL PROPERTY
INSURANCE. IT IS UNDERSTOOD THAT the college IS NOT RESPONSIBLE OR IN ANY
WAY LIABLE FOR THE LOSS, THEFT, OR DAMAGE OF PERSONAL PROPERTY BELONGING
TO RESIDENTS.
Liability
By signing this application, you will be subject to the Office of Residential Life policies, procedures, rules and regulations; in addition, to those governing the college. Failure to adhere to the rules or regulations may result in disciplinary sanction, including but not limited to; residence hall eviction, college suspension or expulsion, or imposition of monetary fines. Please refer to the student handbook/academic planner.
Talladega College is committed to the principle of the equal educational opportunity, equal employment opportunity, and affirmative action. Talladega College does not discriminate on the basis of race, color, sex, disabilities, age, religion, national origin, or veteran status pursuant to the requirements of the Title IX of the Educational Amendments of the 1972, the Rehabilitation Act of 1973, or any other applicable statutes.
Signature of Applicant
Date
Note: The $200.00 Housing Fee is non-refundable.
Failure to complete the entire Housing Application will delay processing.
I agree to abide by the regulations of Talladega College pertaining to dormitory life and student code in general.
Enter Name: