Barton County Community College

Housing Application

Term for which application is made:

Term Code:

Date:
Name:
Street Address:
City:	State:
Zip Code:	Telephone Number:
E-mail Address:
Social Security Number: (Last 4 digits)
Sex:	Birth Date:
Person to be notified in case of emergency:
Relationship to this person:
Address: (Street or Route, City, State, Zip)

Entering Classification: Freshman Sophomore

My choices in order of preference are:
Phase I (units directly north of the center Housing parking lot)
Phase II (units south of the center Housing parking lot)
Phase III (suites)
Phase IV (3 story dorm suite style)
No choice

Roommate Choice:
I would like a roommate with the same major Yes No
Major:
Number of students in your high school graduating class:
Do you smoke? Yes No
Would you object to a roommate who smokes? Yes No

Type of music you like:
Hobbies/ Interests:

Do you stay up past midnight? Yes No
Get up before 8 a.m.? Yes No
Will you use your visitation privileges frequently? Yes No
Do you have a physical condition that requires consideration? Yes No
Describe briefly:
Will you be participating in a varsity sport or in a performance group at Barton? Yes No
If so, which one?

Band	Forensics	Soccer
Basketball	Golf	Tennis
Baseball	Hilltop Singers	Track/CC
Cheerleading/ Yell Leading	Honors Program	Trainer
Cougarettes	Mascot	Volleyball
Dance Line	Softball

Are You on scholarship for this support? Yes No

A housing contract will be mailed to the prospective student when the college receives this application and the deposit fee. Make checks payable to Barton County Community College. Clip and return to: Office of student Housing, Barton County COmmunity College, 245 NE 30 Road, Great Bend, KS 67530