HOWARD COLLEGE HOUSING APPLICATION
Indicate the term and year for which you are applying:
Academic Year ______ Spring ______
Mini ______
Summer I ______
S
ummer II _______
Name: _____________________________________________________________________________________________________
Last First Middle
Mailing Address: _____________________________________________________________________________________________
Street City State Zip
SS#:_________________Howard College ID#:______________ E-Mail Address:_____________________________________
Home Phone # _________________________________ Cell Phone # _________________________________________
Date of Birth: ___________ Male_____ Female______ Ethnicity: Black_____ Hispanic_____ White_____ Other ______
Roommate Preference: _______________________________________________________________________________________
What is your area of study? ____________________________________________________________________________________
Will you be a member of any school sponsored team or organization? __________________________________________________
If you will have a vehicle on campus, please provide the license plate number: _____________________________________________
__________________________________________________________________________________________________________
Emergency Contact Information:
Parent/Guardian Name(s): _____________________________________________________________________________________
Phone: Home _____________________________________ Work : ________________________________________
List a second contact:_______________________________________________ Phone ___________________________________
Medical Information:
Insurance Company: _________________________________________Policy # ____________________Group #________________
Insurance is under what name? _________________________________________________________________________________
Effective January 1, 2010 all students residing in residence halls on college campus’ are required by state law to have
received a vaccination for bacterial meningitis at least ten days prior to taking residence. All residents must include proof of
vaccination when submitting this application.
List any medications you are allergic to and/or medical conditions that may be pertinent to the type of medical attention you receive:
__________________________________________________________________________________________________________
Liability Release: I release Howard College, its employees and representatives from any responsibility for incidents that cause
me physical, mental, or monetary loss or damage.
Have you ever been convicted of a felony? ______ No ______Yes (if yes please explain on separate sheet of paper)
Date: ________________________ Applicant Signature: _____________________________________________________________
This application and contract become valid when completed and returned with a $100 room deposit made payable to
Howard College. Deposits are refundable only if requested by July 15 for the academic year, December 15 for new housing
applicants for the spring semester, and May 1 for summer terms. All Housing fees are subject to change without notice.
If you have any questions, please contact:
Turner Hall at 432-264-5300 or Partee Complex at 432-264-5200 Return this application and deposit to:
Howard College Housing Office * 1001 Birdwell Lane * Big Spring, TX 79720
OFFICE USE
Received Application________________
Received Deposit ________________
Received Meningitis Form____________
Sent Request for ___________________
___________Date __________________
Sent Confirmation Letter _____________
Fall _______
Residence Halls are located on the
Big Spring and SWCD campuses only
HOWARD COLLEGE RESIDENCE HALL CONTRACT
This agreement, between the Howard County Junior College District, a state institution, hereinafter referred to as “District” and:
____________________________
Social Security #
HC Fall and Spring Terms HC Summer and Mini Terms
All Rooms $750.00 Summer* $325 each session + $20 laundry fee = $345
Meals $1,612.00 Mini* $225 + $20 laundry fee = $245
Laundry Fee $ 50.00
Tax $133.00 *A meal plan is not available for these terms.
Total $2,545.00
Student agrees to pay the established rate for room and board in the District Residence Halls for the amount specified and the contract period indicated
above. HC reserves the right to change prices without notice. All students residing in the Residence Halls are required to purchase the meal
plan.
Payment Agreement (Check One)
______Scholarship (please specify what will be covered) ______ Full room & board ______ Room only _______________ $ amount
Payment in Full (Due at registration.) (Student must pay in full for summer and mini)
Installment Plan: First payment due at registration; remaining payments due on dates indicated by the Business Office. See Housing and
Food Service Information Sheet for exact amounts.
TRC/VR pays in full. If in part, amount $___________________
Payment is due at the time student registers for classes and/or moves into the residence halls. Room rent is non-refundable regardless of reason for
withdrawal from the residence hall. Breach of contract does not release student from financial obligation to the District.
Student Conduct
Student agrees to abide by the terms and conditions of this contract, District Catalog, Student Handbook, Residence Hall Supplement, and other rules
and regulations governing the conduct of students which are now in effect and any that may be reviewed and published at a later date. The Student
Handbook and Housing Supplement may be found by logging on to: www.howardcollege.edu
under Forms & Publications. It is the student’s
responsibility to become knowledgeable of policies and procedures.
All rooms are subject to entry at reasonable times by residence hall supervisors and other college officials to check the condition of rooms, the need
for repairs, or to make repairs. The college reserves the right to enter any room to maintain discipline and to provide security of student’s property. If
possible, room entry will be arranged in advance; however, authorized representatives of the college shall have the immediate right to enter in case of
an emergency or when circumstances warrant strong evidence of violation of college policies. In order to control the use of illegal drugs in the residence
halls, the District reserves the right to use the services of law enforcement and/or private agencies to search for drugs in the residence halls, including
students’ rooms at any time. These searches may be conducted on a random basis and without notice to students.
Liability
Although Howard College and the Housing department will exercise reasonable efforts to protect student property, Howard College and the Housing
department are not liable for loss from theft or damage to any property belonging to students or guests. All students are urged to make sure that
personal properties are covered by insurance, either with their parents’ homeowners’ insurance policy or by a special student policy available for this
specific purpose by an insurance firm specializing in this type of coverage.
I hereby agree to assume and be primarily responsible for all rental payments and other obligations provided for above. In witness whereof
the parties hereto have executed this agreement as of:
__________________________________________________ _________________________________
Student’s Signature Date
__________________________________________________ _________________________________
Residence Hall Director Signature Date
The Howard County Junior College District does not discriminate on the basis of race, color, national origin, sex, disability, age, religion, veteran
status, or any other legally protected status in educational programs, activities, admission, or employment practices. The following position has been
designated to handle inquiries regarding the non-discrimination policies: Director of Human Resources, 1001 Birdwell Lane, Big Spring, TX 79720
Revised 7/10/2018
_________________________________________________________________________
*Last Name First Middle Initial
*Hereinafter referred to as “student”:
Occupancy term covered by this contract (please select one):
Academic Year
Spring______ Mini_______Summer I_______ Summer II_______ Fall_______
Cost per semester
Fall _______