Fillable Bryant Residence Hall Application (North Georgia Technical College)

Fill Online, Printable, Fillable, Blank Bryant Residence Hall Application (North Georgia Technical College) Form

Use Fill to complete blank online NORTH GEORGIA TECHNICAL COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Bryant Residence Hall Application (North Georgia Technical College)

On average this form takes 23 minutes to complete

The Bryant Residence Hall Application (North Georgia Technical College) form is 17 pages long and contains:

  • 6 signatures
  • 15 check-boxes
  • 60 other fields

Country of origin: US
File type: PDF

U.S.A. forms for North Georgia Technical College

BROWSE NORTH GEORGIA TECHNICAL COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Bryant Residence Hall Application
Return the following:
Signed Application
Signed Housing Contract
Signed Meningococcal Statement
$150 deposit - Check or money order made payable to NGTC
To: North Georgia Technical College
ATTN: Housing
PO Box 65
Clarkesville, GA 30523
Fax to 706-754-7777
Name:
NGTC Student ID #
Address:
City: State:
Zip Code:
Phone Number: Birth Date:
Email:
Program of Study:
Gender: Male
Female
Requested Move-In Date:
Year:
Term:
Summer
Fall
Spring
Emergency Contact Information (If under 18 years of age, MUST be a parent or legal guardian)
Name:
Relationship:
Address:
City: State:
Zip Code:
Phone Number: Second Phone Number:
Email:
Contact Information for Notification if YOU are MISSING
Name:
Relationship:
Address:
City:
State:
Zip Code:
Phone Number:
Second Phone Number:
Email:
Student Information
Save a copy of the application, contract, and statement for your records!
NGTC Residence Hall Application, Page 1 of 2
Disability Information
Do you plan to have an automobile on campus?
Yes
No
If yes, list:
Year:
Model: Color:
Tag Number:
Room Request: Private Room Semi-Private Room
NOTE:
A private room costs more per term than a semi-private room and is subject to availability. If the number
of residents exceeds the number of available rooms, semi-private rooms will be assigned in the following priority:
1.
Resident Assistants
2.
Students with seniority in the residence hall
3.
New residents (based on the date application was received)
If a semi-private room is desired or required, do you have a person with whom you would like to share a room?
Yes If yes, list: (Must be a student living in the residence hall)
No (A roommate may be assigned.)
NGTC is committed to providing access for all people with disabilities and will provide accommodation if notified. If special
accommodations
or service animals are needed, please contact Kay Morgan at 706-754-7828 or 1701 Hwy 197 N, Clarkesville,
GA 30523
or kmorgan@northgatech.edu. If possible, please provide requests for special accommodations at least one month prior to the
anticipated
occupancy.
I understand that it is my obli
gation to review the rules and regulations of NGTC and Bryant Residence Hall. I agree to abide by these rules
and regulations. Further, I accept financial responsibility for damages I cause and missing items I remove; both in my assigned room and
on the campus at large.
Student Signature Date
As set forth in the student catalog, North Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender identification, religion, disability, age,
political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). For complaints or information, contact Mike
King, VP of Student Affairs (706- 754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500 HWY 197 N, Clarkesville, GA 30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form,
found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information
requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington,
D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. 3/22/18
Resident Acknowledgement and Agreement
Room Information
Automobile Information
NGTC Residence Hall Application, Page 2 of 2
click to sign
signature
click to edit
RESIDENCE HALL CONTRACT
THIS CONTRACT SUPERCEDES ALL PRIOR AGREEMENTS.
NOTE: Execution of this contract d
oes not guarantee that space will be available in the residence hall. Space is available and assigned on a first
come, first serve basis, though full time students may be given priority. The date on which the completed application, contract, and housing deposit
are received by Student Affairs will establish priority for room assignment. NGTC will assign accommodations without regard to race, religion, color,
or national origin. NGTC does not guarantee assignment with a specific roommate or room. Roommate requests are granted when space is
available and the request is mutual. NGTC reserves the right to assign or reassign space (with 24 hours’ notice) for the benefit of an individual
student, living unit, or to accommodate changes in occupancy patterns. Students for whom space is not available will be assigned to a waiting list
and will be notified when space becomes available.
This is a binding contract, made and entered into this date
, for the year
, and the indicated term:
(
Fall
Spring
Summer, by and between, North Georgia Technical College, hereinafter identified as NGTC, and the following, hereina
fter
identified as student or resident.
__________________________
Last Name
First Name Middle Initial Student ID #
Whereas, in signing this contract the student has made application for living accommodations, room and board included in the NGTC residence hall
and whereas, NGTC has assigned such accommodations to the student for the academic year or any remaining parts thereof, unless otherwise
stated, exempting Acts of God, Strike, Natural Disasters and/or other occurrences not under the control of NGTC;
Now therefore, NGTC and the student agree as follows:
1.
ASSIGNMENT OF SPACE-ELIGIBILITY:
a)
NGTC cannot make a housing assignment until the student has been officially accepted by ADMISSIONS.
2.
PERIOD OF CONTRACT:
a)
NGTC operates its residence hall on a term basis and fees are assessed each term. The contract is for the entire academic year or
remaining portion of the academic year. Thus the student agrees that onc
e the housing application and housing deposit have been
accepted by NGTC, the student will live in the NGTC residence hall and will pay all residence hall fees during the period of the contract.
The student must be enrolled in a minimum of 12 credit hours at the time of check-in and at the completion of the drop/add period at
NGTC each term of the academic year or the contract will automatically terminate. The contract will automatically terminate upon non-
enrollment status.
b)
Students who graduate or leave NGTC before completion of the current academic year may request to be released from the contract by
contacting the Dean of Student Affairs in writing of their change in status.
c)
A space will be held for a student upon the receipt of a completed application, contract, addendum(s) and a $150 housing
deposit. The housing deposit is not transferable to another person.
d)
The $150 deposit is not refundable if the student does not occupy the room. If the student does not occupy the room because he or she
graduates or withdraws from NGTC due to illness before the beginning of the term, the $150 will be refunded upon written request if no
other financial obligations to NGTC exist. If other fi
nancial obligations exist, the $150 will be applied towards those obligations.
e)
To be eligible to receive a refund of the deposit, at completion of a term the student must schedule a checkout time with a Resident
Assistant (RA). The RA will complete a checkout form that
reports the room’s condition. The room must be left in good condition and
residence hall keys and student ID must be returned. Failure to check out properly will result in forfeiture of the deposit.
NGTC reserves the right to refuse housing to any student who is delinquent in the payment of bills to NGTC, who has demonstrated an
unwillingness to abide by the NGTC Code of Conduct or other published rules and regulations of NGTC (or who exhibits behavior which is
incompatible with the maintenance of order and propriety in the residence hall).
Important: This contract, unless otherwise provided, shall be binding for the specified term and year of residence by the student.
Please read it carefully before signing.
3.
SPECIAL NEEDS: NGTC is committed to providing access for all people with disabilities if notified. If special accommodations or service animals
are needed, please contact Kay Morgan
at 706-754-7828 or 1701 Hwy 197 N, Clarkesville, GA 30523 or kmorgan@northgatech.edu. If
possible, please provide requests for special accommodations at least one month prior to the anticipated occupancy.
4.
BOARD: All residents are required to take a board plan. Food service is provided to the individual resident who will be required to show
appropriate identification before receiving each meal. Food service privileges are non-transferable in part or in whole. Students are not allowed to
cook except in the designated kitchen area where appliances are provided for resident use.
5.
RESPONSIBILITY FOR DAMAGE: The student is responsible for the condition of the room furnishings assigned to him/her and shall reimburse
NGTC for all damage to or loss of these accommodations and furnishings. Residents may also be required to share in the expense of repair or
replacement of any property or cleaning in areas commonly used by the residents. Charges will be assessed against the student by NGTC and
must be paid promptly. Determination of the amount of such loss or damage shall be made by NGTC at its sole discretion. Failure to pay
assessment will result in a hold on the student’s registration, graduation, and/or issuance of official transcripts.
6.
PAYMENT OF CHARGES: The student agrees to pay all room and board fees and other properly billed charges at the time scheduled by
NGTC. Failure to pay will result in a hold being placed on the student’s record, which will prohibit further enrollment, issuance of official
transcripts and/or other records. Failure to timely pay charges constitutes a breach of contract by the student and may also cause the student to be
removed from student housing.
7.
HEALTH AND SAFETY CHECKS: Health and safety checks are completed at least once each semester. The purpose of these checks is to
identify and resolve any potential facility or sanitation problems. All students will receive advance notice of scheduled health and safety checks.
During a health and safety check, a RA or other representative of NGTC will enter each room to check the condition. If there are items that do
not meet the advance notice requirement list, the resident will be assessed a fine. If there are items that require immediate resident action, the
resident will be given a designated amount of time to correct the condition. Failure to comply within the allotted time may result in an
assessment of an administrative fee and/or referral to the Vice President of Student Affairs for a Student Code of Conduct violation.
Residents may also be assessed charges for repair for damages noted during the health and safety check. Residents are not required to be
present at a health and safety check although it is preferred.
8.
ENTERING ROOMS: NGTC reserves the right to the fullest extent permitted by law to enter a room for the purpose(s) of safety, occupancy
verification, facility improvements, conducting maintenance, or health and safety checks, managing rooms in the event of an epidemic or
emergency that jeopardizes the well-being of the occupant or other students, and/or maintaining a quiet environment where residents may
sleep and study. Student rooms may be searched for legal cause by civil authorities. In cases of suspected criminal violations, a search
warrant may be used to authorize the search absent exigent circumstances. Whenever possible, NGTC will attempt to notify residents of
intended room or apartment entry.
9.
GUESTS AND VISITORS: Residents are responsible for the conduct of their guests and visitors. Guests may be allowed to stay until 10:00 p.m.
Sunday thru Wednesday. Guests may be allowed to stay until midnight on Thursday, Friday and Saturday. No overnight guests allowed, meaning
resident or non-resident guests. Failure to comply with this rule may result in disciplinary action for the resident.
10.
RESIDENCE HALL MEETINGS: There will be at least one residence hall meeting per term. Students are required to attend all residence hall
meetings that are designated MANDATORY by the Vice President for Student Affairs or his/her designee. Failure to attend a MANDATORY
Residence Hall Meeting may result in disciplinary action.
11.
NGTC LIABILITY: Although security precautions are taken, NGTC does not assume any legal obligations to pay for injury to person (including
death) or loss, theft or damage to items of personal property which occurs in its buildings or on its grounds prior to, during, or subsequent to the
period of this contract including damages caused by employees of NGTC in the performance of their duties. Students or their parents are
encouraged to carry appropriate insurance to cover such losses.
12.
TERMINATION BY THE STUDENT:
a)
A student may cancel the contract because of documented injury or illness, which necessitates withdrawal from NGTC or because of
documented changes in personal circumstances that necessitate different living arrangements.
b)
A student who must fulfill a student internship whose assignments necessitate residency away from the campus must comply with the
contract during the terms the student is on campus.
c)
A resident who forfeits the privilege to live in the residence hall and who is asked to vacate the room as a result of disciplinary action is not
eligible for a refund of that term’s fees or the housing deposit. Board plans may be terminated at the discretion of the Vice President of
Student Affairs or his/her designee.
13.
NOTIFICATION: Federal law permits NGTC to disclose to parents/guardians violations of not only local, state, and federal laws but also college
policies and rules governing the use of and/or possession of alcohol or controlled substances. (Section 952, Alcohol or Drug Possession
Disclosure, of the Higher Education Act 10/99) All violations of drugs and/or alcohol policies will be reported in an effort to curb abuse.
Please initial __________________
14.
USE OF FACILITIES:
•
This agreement is not intended to convey any tenancy or other property interest to the student, the intent being to create a licensor/licensee
relationship subject to the terms and conditions stated herein.
•
Upon receipt of a room assignment, this contract guarantees a space (not a particular room) in the residence hall.
•
NGTC reserves the right to make assignments, reassignments and temporary assignments as considered necessary.
•
Room changes may not be made without the approval of the Dean of Student Affairs.
•
In the event that the accommodations assigned to the student are destroyed or otherwise not available and NGTC does not furnish other
accommodations, the contract shall terminate immediately.
•
The student agrees to comply with all Federal and State laws, City ordinances, and NGTC policies and procedures, including those regarding the
possession or use of alcoholic beverages and illegal drugs, and agrees that his/her room shall not be used for any purpose contrary to such.
•
Explosives, firearms or other weapons, fireworks, and chemical related items are not permitted in the residence hall.
•
The use of hotplates, microwave ovens, candles, space heaters, or any other item described in the NGTC Course Catalog/Student Handbook is
strictly forbidden. NGTC reserves the right to remove and confiscate any unauthorized or dangerous electrical item.
•
In addition to any other disciplinary action or fines, students may be required to remove stereos, musical instruments, or other audio devices
from their room if used in a manner that unreasonably disturbs other residents. Amplification devices are strictly prohibited. What constitutes an
amplification device shall be determined solely by the Dean of Student Affairs.
•
Darts and dartboards are not allowed in the residence halls.
•
Each student is issued a key to his/her room. Loss of this key or failure to return the key at the time of checkout will result in a charge of $15,
plus any additional fees deemed by the Business Office. Loss of the front door key will also cost the student $15. Keys may not be duplicated.
Auxiliary locks may not be installed nor may residents tamper with existing locks.
•
No pets are allowed in the residence hall unless the animal has been approved by NGTC Disability Services (contact information above).
•
Sales and solicitations in any form including but not limited to religious solicitation are prohibited unless authorized in writing by the Dean of
Student Affairs. Residents may not allow outside salespersons to conduct any sales, demonstration, or presentations of a product in their
room or in the residence hall without permission from the Dean of Student Affairs.
•
NGTC property, including furnishings, may not be moved from the assigned area within the residence hall without authorization from the Dean of
Student Affairs. Water filled furniture will not be permitted. Students will be held responsible for the condition of his or her room and must pay for
any damages to NGTC property. Damages or loss to common areas will be billed to all hall residents if the person(s) responsible cannot be
determined. NGTC reserves the right to determine the amount of the damages and make repairs.
•
NGTC has policies regarding check-in, room changes, and checkout. Failure to comply with these policies may result in fines, including but not
limited to the forfeiture of the housing deposit. Students may not occupy the dormitory during breaks in the NGTC academic calendar, which
may include holidays. Residents will be given advance notice of the breaks when the dormitory will be closed.
•
The Residence Hall is a co-ed facility; however, co-ed living in individual rooms is strictly prohibited.
15.
SMOKING AND TOBACCO USE REGULATIONS: Smoking and the use of tobacco in any form, including e-cigarettes regardless of tobacco
content, is STRICTLY PROHIBITED on NGTC property including inside Bryant Residence Hall and any assigned dorm rooms.
16.
ALCOHOL USE REGUALTIONS: The use or possession of alcoholic beverages and/or beverages identified as non-alcoholic beer are
STRICTLY PROHIBITED on NGTC property including inside Bryant Residence Hall and any assigned dorm rooms.
17.
GENERAL: Any exceptions to this contract must be approved in writing by the Dean of Student Affairs. A student who contracts for
NGTC housing is expected to fulfill all provisions of this agreement, and failure to do so may result in the withholding of the student’s access to
their account, official transcripts, registration, and housing deposit. If any Section or Subsection of this contract is ruled to be illegal or invalid, this
will not affect the validity of enforcement of the remainder of the provision of the contract. This contract shall be interpreted under the laws of
the State of Georgia. If the student is less than 18 years of age, the parents or legal guardian will become a party to this contract and will
sign as evidence of accepting this responsibility.
Student Name-PRINT
Parent/Legal Guardian Name-Print
Relationship to Student
Student Signature
Parent/Legal Guardian Signature
Student Affairs Staff Signature
As set forth in the student catalog, North Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender identification, religion, disability,
age, political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). For complaints or information,
contact Mike King, VP of Student Affairs (706- 754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500 HWY 197 N, Clarkesville, GA
30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint
Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the
information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue,
S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. 3/22/18
click to sign
signature
click to edit
click to sign
signature
click to edit
Residence Hall
Meningococcal Statement
I have been vaccinated against meningococcal disease OR I have reviewed the information regarding
the disease provided to me by North Georgia Technical College. I understand that I am not required to
take the Meningitis vaccination, but I have been advised where to obtain the vaccination if I desire to
do so.
Printed Name of Student and/or Legal Guardian Date
Signature of Student, or if Student is a Minor, Signature of Parent or Legal Guardian
Meningococcal Vaccine information provided by NGTC
Relationship to Student
Vaccine Information Statement
(Interim) Meningococcal Vaccine
(10/14/2011) 42 U.S.C. § 300aa-26
Department of Health and Human
Services Centers for Disease Control
and Prevention
Also available online: http:// www.cdc.gov/vaccines/hcp/vis/vis -statements/mening.html
Many Vaccine Information Statements are available in español and other languages. See http:// www.immunize.org/ vis .
As set forth in the student catalog, North Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender identification , religion, disability, age,
political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). For complaints or information, contact Mike
King, VP of Student Affairs (706- 754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500 HWY 197 N, Clarkesville, GA 30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form,
found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information
requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington,
D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. 9/21/16
Important:
Read the Meningococcal Vaccine information provided by North Georgia Technical College before signing.
The Meningococcal Vaccination may be obtained at the Habersham County Health Department.
For more information, call 706-778-7156 or visit your local county health department.
click to sign
signature
click to edit
NorthGeorgiaTechnicalCollege–ResidenceHallContractAddendum
2020‐2021AcademicYear
ThisaddendumtotheNGTCResidenceHallContract,isenteredintothisdate_______________,forthe
year________________,andindicatedterm:Fall Spring Summer
_______________________ _______________________ ___________ ________________________
LastName FirstName MiddleInitial StudentID#
*Thecontractaddendumisfortheentireacademicyearorremainingportionoftheacademicyear.
COVID‐19AcknowledgementofRisk
Thenovelcoronavirus,COVID‐19,hasbeendeclaredaworldwidepandemicbytheWorldHealthOrganization.
COVID‐19isextremelycontagiousandisbelievedtobespreadmainlyfromperson‐to‐personcontact.Asa
result,federal,stateandlocalhealthagenciesandgovernmentshaverecommendedanumberofpreventative
measures.
Studentswholiveoncampusareencouragedto:
Practicegoodhandhygienebyeitherwashinghandsoftenwithsoapandwaterforatleast20seconds
orbyusingalcohol‐basedhandsanitizerwhichcontainsatleast60%alcohol
Avoidclosecontactwithpeoplewhoaresick
Stayhomeifyou’refeelingsickandcontactyourhealthcareproviderregardingyoursymptoms
Coveryournoseandmouthwithatissueoryoursleevewhencoughingorsneezing
Cleananddisinfectfrequentlytouchedobjectsandsurfaces
Andpracticesocialdistancingstrategies,whereapplicable.
Althoughtherearealotofunknownsatthispoint,NorthGeorgiaTechnicalCollegeisstrategizingcleaning,
programminganddistancinginitiativestopreventthespreadofdisease,whilestillprovidingthecommunity
andsupportyouexpectfromus.
Asofrightnow,ourplansinclude:
Assigningeachresidentstudenttoasingleroom–noroommateassignmentsforthefallterm–room
andboardassessedatthesemi‐privaterateof$2000perterm
Increasingtouchpointcleaningincommonareaspaces
Increasingcleaningofbathroomstotwiceperdaywhenclassesarescheduled
Providingresourcesforstudentstoself‐cleanorwipedownbathroomswhenclassesarenot
scheduled,ifdesired
Consideringanadjustmentinourguestprocedurethatmaytemporarilyrestrictoralterthenumberof
guestsallowedinastudent’sroom
Encouragingresidentsocialdistancingandotherpersonalhygienepractices
Andpossiblyrelocatinganyaffectedstudentstoanotherroomintheresidencehallorhavethe
studenttovacatetheresidencehallandreturntotheirhomelocationintheeventofarequiredself‐
quarantineorisolationasrecommendedbytheGeorgiaDepartmentofPublicHealth.
Becauseofthefluidnatureofthepandemic,wearecontinuingtoengageinconversationsandreviewingbest
practicesandguidelinesfromtheTechnicalCollegeSystemofGeorgia,theCentersforDiseaseControl(CDC)
andGeorgiaDepartmentofPublicHealthabouthowtocontinuetomaintainahealthyon‐campus
environmentinpreparationforyourarrivalinfall.
AlthoughNorthGeorgiaTechnicalCollegehasputinplacepreventativemeasurestoreducethespreadof
COVID‐19,theCollegecannotguaranteethatyouwillnotbecomeexposedtoorinfectedwithCOVID‐19while
livinginon‐campusfacilities.Further,livingoncampuscouldelevatetheriskofcontractinganycontagious
illnesssimplyduetothedensepopulationintheresidencehall.
IacknowledgethecontagiousnatureofCOVID‐19andtheriskofpossibleexposurebylivingoncampus.I
furtheracknowledgethattheriskofbecomingexposedtoorinfectedbyCOVID‐19intheresidencehalls
mayresultfromtheactions,omissionsornegligenceofmyselfandothers.Ifexposedtoorinfectedby
COVID‐19,Iacknowledgeandagreetopossiblerelocationtoanotherroomintheresidencehallorvacating
theresidencehallintheeventofarequiredself‐quarantineorisolationasrecommendedbytheGeorgia
DepartmentofPublicHealth.
StudentSignature Parent/LegalGuardianName‐Print RelationshiptoStudent
Parent/LegalGuardianSignatureStudentAffairsStaffSignature
As set forth in the student catalog, North Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age,
political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). For complaints or information,
contact Mike King, VP of Student Affairs (706- 754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500 HWY 197 N, Clarkesville,
GA 30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA
Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-
9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or
letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410,
by fax (202) 690-7442 or email at program.intake@usda.gov.7/8/2020
click to sign
signature
click to edit
click to sign
signature
click to edit
Student Copy
Meningococcal Vaccines
What You Need to Know
Meningococcal disease is a serious bacterial illness. It
is a leading cause of bacterial meningitis in children
2 through 18 years old in the United States. Meningitis
is an infection of the covering of the brain and the spinal
cord.
Meningococcal disease also causes blood infections.
About 1,000–1,200 people get meningococcal disease
each year in the U.S. Even when they are treated with
antibiotics, 10–15% of these people die. Of those who
live, another 11%–19% lose their arms or legs, have
problems with their nervous systems, become deaf, or
suffer seizures or strokes.
Anyone can get meningococcal disease. But it is most
common in infants less than one year of age and people
16–21 years. Children with certain medical conditions,
such as lack of a spleen, have an increased risk of getting
meningococcal disease. College freshmen living in
dorms are also at increased risk.
Meningococcal infections can be treated with drugs such
as penicillin. Still, many people who get the disease die
from it, and many others are affected for life. This is why
preventing the disease through use of meningococcal
vaccine is important for people at highest risk.
There are two kinds of meningococcal vaccine in the
U.S.:
• Meningococcal conjugate vaccine (MCV4) is the
preferred vaccine for people 55 years of age and
younger.
• Meningococcal polysaccharide vaccine (MPSV4)
has been available since the 1970s. It is the only
meningococcal vaccine licensed for people older
than 55.
Both vaccines can prevent 4 types of meningococcal
disease, including 2 of the 3 types most common in the
United States and a type that causes epidemics in Africa.
There are other types of meningococcal disease; the
vaccines do not protect against these.
Routine vaccination
Two doses of MCV4 are recommended for
adolescents 11 through 18 years of age: the first
dose at 11 or 12 years of age, with a booster dose at
age 16.
Adolescents in this age group with HIV infection should
get three doses: 2 doses 2 months apart at 11 or 12 years,
plus a booster at age 16.
If the first dose (or series) is given between 13 and
15 years of age, the booster should be given between
16 and 18. If the first dose (or series) is given after the
16
th
birthday, a booster is not needed.
Other people at incr
eased risk
• College freshmen living in dormitories.
• Laboratory personnel who are routinely exposed to
meningococcal bacteria.
• U.S. military recruits.
• Anyone traveling to, or living in, a part of the world
where meningococcal disease is common, such as
parts of Africa.
• Anyone who has a damaged spleen, or whose spleen
has been removed.
• Anyone who has persistent complement component
deficiency (an immune system disorder).
• People who might have been exposed to meningitis
during an outbreak.
Children between 9 and 23 months of age, and anyone
else with certain medical conditions need 2 doses for
adequate protection. Ask your doctor about the number
and timing of doses, and the need for booster doses.
MCV4 is the preferred vaccine for people in these
groups who are 9 months through 55 years of age.
MPSV4 can be used for adults older than 55.
2
Meningococcal vaccine
3
Who should get meningococcal
vaccine and when?
1
What is meningococcal
disease?
VACCINE INFORMATION STATEMENT
Many Vaccine Information Statements are
available in Spanish and other languages.
See www.immunize.org/vis
Hojas de información sobre vacunas están
disponibles en español y en muchos otros
idiomas. Visite www.immunize.org/vis
Some people should not get
4
meningococcal vaccine or
should wait.
6
What if there is a serious
reaction?
7
The National Vaccine Injury
Compensation Program
Severe problems
Serious allergic reactions, within a few minutes to a few
hours of the shot, are very rare.
• Anyone who has ever had a severe (life-threatening)
allergic reaction to a previous dose of MCV4 or
MPSV4 vaccine should not get another dose of either
vaccine.
• Anyone who has a severe (life threatening) allergy to
any vaccine component should not get the vaccine. Tell
your doctor if you have any severe allergies.
• Anyone who is moderately or severely ill at the time
the shot is scheduled should probably wait until they
recover. Ask your doctor. People with a mild illness
can usually get the vaccine.
• Meningococcal vaccines may be given to pregnant
women. MCV4 is a fairly new vaccine and has not
been studied in pregnant women as much as MPSV4
has. It should be used only if clearly needed. The
manufacturers of MCV4 maintain pregnancy registries
for women who are vaccinated while pregnant.
Except for children with sickle cell disease or without a
working spleen, meningococcal vaccines may be given
at the same time as other vaccines.
What should I look for?
Look for anything that concerns you, such as signs of
a severe allergic reaction, very high fever, or behavior
changes.
Signs of a severe allergic reaction can include hives,
swelling of the face and throat, difficulty breathing, a
fast heartbeat, dizziness, and weakness. These would
start a few minutes to a few hours after the vaccination.
What should I do?
• If you think it is a severe allergic reaction or other
emergency that can’t wait, call 9-1-1 or get the person
to the nearest hospital. Otherwise, call your doctor.
• Afterward, the reaction should be reported to the
Vaccine Adverse Event Reporting System (VAERS).
Your doctor might file this report, or you can do it
yourself through the VAERS web site at
www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS is only for reporting reactions. They do not give
medical advice.
A vaccine, like any medicine, could possibly cause
serious problems, such as severe allergic reactions. The
risk of meningococcal vaccine causing serious harm, or
death, is extremely small.
Mild problems
As many as half the people who get meningococcal
vaccines have mild side effects, such as redness or pain
where the shot was given.
If these problems occur, they usually last for 1 or 2 days.
They are more common after MCV4 than after MPSV4.
A small percentage of people who receive the vaccine
develop a mild fever.
The National Vaccine Injury Compensation Program
(VICP) is a federal program that was created to
compensate people who may have been injured by
certain vaccines.
Persons who believe they may have been injured by a
vaccine can learn about the program and about filing a
claim by calling 1-800-338-2382 or visiting the VICP
website at www.hrsa.gov/vaccinecompensation.
8
How can I learn more?
Ask your doctor.
• Call your local or state health department.
• Contact the Centers for Disease Control and
Prevention (CDC):
- Call 1-800-232-4636 (1-800-CDC-INFO) or
- Visit CDC’s website at www.cdc.gov/vaccines
Vaccine Information Statement (Interim)
Meningococcal Vaccine
Office Use Only
42 U.S.C. § 300aa-26
10/14/2011
Brief fainting spells and related symptoms (such
as jerking or seizure-like movements) can follow
a vaccination. They happen most often with
adolescents, and they can result in falls and injuries.
Sitting or lying down for about 15 minutes after
getting the shot—especially if you feel faint—can
help prevent these injuries.
5
What are the risks from
meningococcal vaccines?
Frequently Asked Questions for Bryant Residence Hall (Retain for your Information)
Is there a curfew for visitors? All outside visitors have to be out of the Bryant Residence Hall each evening by 10:30 pm, Sunday-Wednesday and
midnight on Thursday, Friday and Saturday. No one under the age of eighteen will be allowed to visit unless they have written permission from the Vice
President for Student Affairs or designee. Residents of Bryant Hall can visit in other students’ rooms as long as the door is partially open.
What size are the dorm rooms? Each room is approximately 15’ X 15’.
Are refrigerators allowed? Yes, the compact size refrigerator works great for dorm rooms. Is there a kitchen? There is a kitchen with a full size stove,
refrigerator, microwave, toaster, and vending machines.
What size are the beds? The beds are twin long size.
What furniture is included? Each room has two twin beds; some have a chest of drawers. No sofas or love seats allowed.
Do I clean my own room? Students are responsible for cleaning their room (there will be periodic checks for cleanliness).
Are laundry facilities available? Washers and dryers are free of charge and are located on the first floor.
What appliances should I leave at home? Do not bring microwaves, toasters, toaster ovens or coffee makers.
Is cable T.V. provided? Each room has cable TV service (students may bring televisions).
Are pets allowed? No, unless approved by Kay Morgan, Special Services, in room 214 of the Clegg Building, 1701 Hwy 197N, Clarkesville, GA
30523 or call (706) 754-7828 or by e-mail at kmorgan@northgatech.edu.
Is phone service provided? Students are responsible for setting up service with a local provider.
May I bring a car to campus? Yes. You are responsible for obtaining a parking permit following the regulations established by the college for operation
of a vehicle on campus. May I bring a bicycle to campus? Yes, there is a bicycle rack provided in the Bryant Residence Hall yard. Each student is
responsible for their own bike and furnishing a lock for safety precautions. Bicycle or similar recreational vehicles are not allowed in the Bryant
Residence Hall.
How will I receive U.S. Mail while I live on campus? Mail may be addressed to the student at NGTC, P O Box 65, Clarkesville, GA 30523.
Resident students may pick up their mail from the Receptionist in the Clegg Building. You are responsible for having your mail forwarded when you
vacate the residence hall to avoid mail being returned to the sender.
What if I need special accommodations? To request special accommodations, contact Kay Morgan, special services, in room 214 of the
Clegg Building, call (706) 754-7828 or by e-mail at kmorgan@northgatech.edu.
What is the policy concerning alcohol at NGTC? The use, possession, distribution or transportation of alcoholic beverages by NGTC students is
strictly forbidden on campus and at any off campus activity that is sponsored by or in the name of any institutional department or group.
What is the smoking policy at NGTC? NGTC is a TOBACCO FREE campus. This includes inside Bryant Residence Hall and any assigned dorm
rooms. Tobacco Violation Citations and fines are issued to violators. Use of any tobacco product is strictly prohibited.
Are computer labs available? No, there is not a computer lab in Bryant Residence Hall. However, the Campus Library and the Student Center has
computers available for use by all students.
Is the Residence Hall wired for computers? Yes, Bryant Residence Hall has Wi-Fi available at no cost.
Suggested Items to Bring
• Pillows, sheets and other bedding (long twin size)
• Toiletries/carrying case/flip-flops for shower
• Cleaning and laundry supplies
• TV/VCR/DVD/Radio
• Telephone (Service is student’s responsibility)
• Towels and washcloths
• Compact refrigerator
• Computer
• Alarm clock
• Pots and Pans, plates and utensils for use in
Kitchen
Prohibited Items - See contract for complete list
• Microwave/Toaster/toasterovens
• Space heaters
• Incense
• Firearms
• Fireworks
• Coffee makers/Hotplates
• Candles
• Alcoholic beverages
• Pets
• Water-filled furniture
• Personal bed - Requires prior medical approval by the Dean of Student Affairs
As set forth in the student catalog, North Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender identification, religion, disability, age, political affiliation or
belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). For complaints or information, contact Mike King, VP of Student Affairs (706-
754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500 HWY 197 N, Clarkesville, GA 30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your
completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email
at program.intake@usda.gov. 3/22/18
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Bryant Residence Hall Application (North Georgia Technical College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document